Your thoughts and input on my situation! Considering surgery.

[earthman1987]

Hello, I've had Gynecomastia since twelve years old. I'm almost 24 now and and i've been heavy from 9 years old to 21. Since then I've lost close to 100 pounds.  I'm now considering Gynecomastia surgery for my situation.  I've been to a few surgeons here in town and in the batch of uploaded pics in the think below I've provided a a proposed operation from a surgeon who does about 50 a year.  I would appreciate all thoughts and advice on my situation, also what your thoughts are on the surgeon's way of going about my surgery. He and a number of other have recommended skin excision, mostly on the left breast.  Thank you for your time. If there are certain surgeons that have a different approach I would like to know!

[DrBermant]

Hello, I've had Gynecomastia since twelve years old. I'm almost 24 now and and i've been heavy from 9 years old to 21. Since then I've lost close to 100 pounds.  I'm now considering Gynecomastia surgery for my situation.  I've been to a few surgeons here in town and in the batch of uploaded pics in the think below I've provided a a proposed operation from a surgeon who does about 50 a year.  I would appreciate all thoughts and advice on my situation, also what your thoughts are on the surgeon's way of going about my surgery. He and a number of other have recommended skin excision, mostly on the left breast.  Thank you for your time. If there are certain surgeons that have a different approach I would like to know!

Congratulations on all of that weight loss. 100 pounds is quite an achievement.

Vertical component skin reduction looks terrible, in my opinion, on male chest especially on animation. Check before after pictures of men, flexing muscle views, bending over views, and videos. Does the doctor have the bending over views of the proposed surgery on male patients?  Check this post that has resources to better understand the issues at hand here.

https://www.gynecomastia.org/smf/index.php?topic=21099.msg143265;topicseen#msg143265

This is compromise surgery and understanding the trade off issues of loose skin and scars is critical education before having surgery.

The other issue is the loose tissue of the belly. If both are eventually to be addressed, the stomach is better done first. Otherwise lift the chest, then do the belly, a tummy tuck can lower the chest again. Then you get to have a revision for the chest? Not the best order of doing things. Here are resources discussing these concepts:

https://www.gynecomastia.org/smf/index.php?topic=22279.msg149750;topicseen#msg149750

So back on point, you are looking for what a doctor's techniques look like as far as leaving loose skin and scar compromise. That does mean what it looks like from different angles, and how it reacts to gravity (bending) and bouncing. That is why checking videos is even better for that evaluation. Beyond that then you need to understand what path a patient needed to take to get there. How much bruising, swelling, pain, return to activity and so forth.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[earthman1987]

As opposed to vertical scars where would the scars be placed?

[DrBermant]

As opposed to vertical scars where would the scars be placed?

I demonstrate the various options in the other posts mentioned above. Words alone just are not enough to show the issue. Scars are better hidden by anatomic structures such as around the areola or under the pectoral muscle crease. The vertical scar is hidden on a female breast by the shadow, but not on the male chest where it stands out very noticeably as an unnatural feature. However, each scar has its compromise and understanding that with words instead of pictures and movies is just nor realistic.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[George Pope, M.D.]

Yours is a difficult case, but I would recommend minimizing the scars placed on your chest.  The goal in gynecomastia surgery is to get guys to feel comfortable out of their shirts on the beach, at the pool, etc.  If you undergo the proposed surgery with that big skin cut-out, you'll have visible scars forever.  At your young age there's a possibility that your skin will shrink considerably after fat and gland are removed.  Do you have a lot of palpable gland tissue?  If so, and it's not just extra skin, find someone who will remove the breast tissue and chest wall fat.  Then give it 6 months to see how your skin contracts.  You may need a skin removal surgery later, but at least you'll be giving your chest a chance to contract (skin) before undergoing a procedure that can leave you with a lot of bad scars.

Regarding the tummy, you can have all of that extra skin removed and be left with a scar that can be hidden by a bathing suit.

Dr. Pope, MD

[Dr. Elliot Jacobs]

What an achievement -- 100 lbs lost!  I am sure you fit better into your clothing and you are also much, much healthier.

Your before and after weight loss photos are dramatic.  What's more, they reveal a significant contraction of your skin.  While you still have some gyne remaining (probably mostly gland since the fat component has been diminished), I don't think you have that much extra skin to deal with.

I would absolutely not recommend having the inverted T technique surgery -- it will leave you with lots of scars -- forever.

In patients I have had who are similar to you, I would actually opt for my minimal scar technique operation and allow the skin to tighten by itself.  While we do not know how much it will tighten, we do know it still has kept some of that ability.  The result would then be evaluated at 6-8 months after surgery.  We may be pleasantly surprised to find that there is no need to tighten skin.  Or, there may be just a little remaining fold under the breast -- probably something you could live with.  Or, if one wanted absolutely tight skin, then we could do a skin tightening procedure -- but the scars would be less because the skin would have tightened in the intervening six months thereby leaving less extra skin to deal with.

Dr Jacobs

[mooninite]

congrats on losing the weight, but life's not fair and we still get screwed once getting into better shape.  your surgery (if you get the loose skin removed as well) will leave scars, probably big ones.  the before/after pics with similar conditions as yours should help you decide if you'd like to go with surgery or not. 

i would get the surgery if i was in your situation, cause i wouldn't want to have that much sagging skin (the little that i do have already bothers me and i'm very critical of myself). 

[DrBermant]

congrats on losing the weight, but life's not fair and we still get screwed once getting into better shape.  your surgery (if you get the loose skin removed as well) will leave scars, probably big ones.  the before/after pics with similar conditions as yours should help you decide if you'd like to go with surgery or not. 

i would get the surgery if i was in your situation, cause i wouldn't want to have that much sagging skin (the little that i do have already bothers me and i'm very critical of myself). 

I have seen many patients over the years who have lost a great deal of weight. Almost all say they would never go back and trade the loose skin for how bad they felt with the extra weight. Yes, weight loss is a compromise. The loose skin can be managed by surgery or body shaping garments. I demonstrate both concepts with before and after pictures and videos on my website. During my office consultations my patients are also given the chance to try on such compression garments. Many leave the office with a garment to help deal with their dislike of the loose skin waiting to stabilize their problem or finish their weight loss. Surgery before the process is complete will result in the need for revision surgery as tissues loosen again with further weight loss. That is why I view the weight loss as the coarse tool of my sculpture and the surgery better reserved for the refinement.

Hope this helps,

Michael Bermant, M.D.

[Dr. Cruise]

Hello,
IMO, you need a full anchor type incision.

Your pictures demonstrate you have considerable skin laxity in both the horizontal and vertical plane. Without tightening the skin envelop in both planes you will still have a loose, saggy chest. As you age, this loose envelope will only get looser.

You have approximately 2 inches of excess skin in the vertical plane (up and down skin laxity). This means that to tighten your chest adequately you will need to remove 2 inches of skin between the infra-mammary fold and the nipple. Clearly, you do not have this much distance. This means that the nipple will, out of necessity, need to be raised approximately 3/4 inch to allow this to occur.

You have approximately 1 inch of excess skin in the horizontal plane. This can only be removed by the short vertical incision extending between the areola and the IMF. The nice thing with your chest is that at the level of the nipple you have hair. This hair will significantly help hide the incision and presumably you will get hairy with age.

Regarding the incisions. Breast reduction incisions on men heal exceptionally well if they are positioned well and are not under tension. Still, I understand the desire to not have visible scars. This must be weighed against the benefit of having a tight chest. In my experience, my anchor lift patients are among the happiest.

Regarding a donut lift skin excision. My opinion is that it may leave a significantly worse scar (albeit, not as long) than an achor lift because you are asking the donut lift to do more than it is capable of doing.

My opinion in summary,
If you do the anchor lift and have it done by an expert surgeons active on this site you will have a tight chest that will last well into your old age.

If you have less skin removed than an anchor lift you likely will be dissappointed and you will almost certainly have a recurrence of saggy skin well before middle age.