What kind of surgery do i need?

[Iamnotannumber]

Hi, 
I'm hoping for some advice.
I was very overweight as a child/teenager. I have managed to lose the weight but I've been left with a flabby chest, excess skin & huge nipples. What kind of procedure do I need & what kind of result can I expect. I had surgery in 1994 on the NHS in 1994 with unsatisfactory results. This has haunted me my whole adult life & really need to get it sorted out. Any advice would be really appreciated. Thank You. 

[Dr. Elliot Jacobs]

It is quite common for breasts to remain after significant weight loss.  You are also dealing with the expected lax skin from having been overweight.  

What to do? Get to your best and most stable weight.  Then, consider living  with your situation -- it is not the end of the world. Or, consult with a gyne surgery expert in your area for a surgical opinion or consider traveling for such expertise.

Dr Jacobs

[Iamnotannumber]

Thank you for your post Dr. It is much appreciated. I have decided that I will have surgery to correct the issue. It is affecting me mentally & having a big impact on my life. I am unsure whether to have the skin removed via the donut procedure as I am unhappy with the size of my nipples & the sagging skin. 

[Dr. Elliot Jacobs]

You should get several opinions from various surgeons.  Remember, a donut procedure will leave a scar completely around the edge of the areola, and, as part of the procedure, the surgeon may need to leave some tissue underneath in order to provide blood to the nipple.  This may result in a less than satisfactory removal of the excess chest tissues.

Another method is to have lipo and possible direct excision of the excess tissue beneath the areola.  The skin will oftentimes tighten considerably and the areolar diameter will undoubtedly shrink to some extent.

Dr Jacobs

[Iamnotannumber]

Thanks for your opinion Dr Jacob's. 

[DrPensler]

While you do not have the best skin elasticity you certainly do not have terrible skin elasticity. What this means is that the results are more unpredictable, it does not mean you will certainly require a large skin excision. The entire discussion with respect to your situation is lengthy as was implied.The key issue is a good physical examination by a surgeon experienced with gynecomastia who can then create a plan that has the optimal possibility for success.

[Iamnotannumber]

Thanks all for your useful advice, it's much appreciated. I have an appointment in April with a surgeon so hopefully I'll be able to rid myself of this. 

[Dr. Schuster]

it actually looks like your breasts and skin issues are significantly different from each other. it also depends on your final goals with respect to "tightness" vs scars. On your left, saggier, side I would strongly recommend a complete mastectomy resection and nipple graft technique (leaving you with a single scar along the IMF as well as around the areola). On your right side you might get by with just a peri-areolar approach however there are always additional issues with residual asymmetry when you don't do the same procedure on both sides. Of course all of this is subject to change after a thorough exam. 

[Iamnotannumber]

I thought i would put an update on here.
I have now seen a couple of surgeons. Both of the surgeons have the same opinion that in my case a conservative approach is best. They have said initially i need lipo & gland removal and hopefully the skin will tighten sufficiently to give a satisfactory outcome. 
After 9 months if the result is not satisfactory then i will need to consider a revision & have the skin removed. This will be included in the cost. 
Considering now whether to go ahead. 

[Litlriki]

Looking at the photos, I think that liposuction and gland removal will do much toward improving the appearance.  It's possible that you'll need a peri-areolar skin resection as well, and this can be safely done under local anesthesia if you need it after nine months to a year.  Peri-areolar skin removal may be adequate, rather than having to add a large incision along the lower chest, and this would also address your concern over areolar diameter.  

[Iamnotannumber]

Thanks for your input Doc.
Both of the surgeons I've seen have said the same that it may possibly correct itself. I live in hope. 
Having one more consultation before I make my final decision. 

[Dr. Schuster]

I think you will need a peri areolar skin reduction together with correction of the gynecomastia.