Need skin removal, but which technique?

[Ohno23]

I lost around 90lbs almost a decade ago. I have a good amount of loose skin, which I can easily grab as shown in the photos below. I've also visited three surgeons for gynecomastia surgery who have all told me I also need some kind of skin removal, so I don't think I'm getting out of this without some scarring. The problem I'm having is how much skin removal I need, because each surgeon had their own opinion:

- One wants to do a double incision (long horizontal scars) with free nipple graft.
- One wants to do a double incision using the pedicle technique (nipple stays attached). I would prefer this over a nipple graft.
- One wants to do a donut incision (skin removed around nipple in a donut shape). They also told me my particular case will have a higher chance of needing a revision.

I was hoping that asking more than 1 surgeon would help me decide, but now I'm even more confused. Obviously, I want the least scarring possible. Double incision would give me the worst possible scars, which leans me towards periareolar/donut incision which only scars around the areolar. But if I'm not suited for it, the complications (areolar/scar stretching, remaining loose skin) could end up looking just as bad if not worse. It just seems like double incision techniques are reserved for the worst cases -- is mine really that bad?


Based on my (hopefully thorough enough) photos below, can you give me your opinion on what kind of incisions will be needed to achieve a non-saggy chest with proper nipple placement? Click here for full-size versions of the images below.