Boomerang Pattern Correction of Gynecomastia

[citydweller]

I'm writing to ask surgeons' advice about the boomerang-pattern gynecomastia surgery for massive-weight loss patients advocated by Dennis Hurwitz. 
I've lost over a hundred pounds, and I'll need some kind of chest-countering surgery involving skin excision.  Frankly, most of the "after" images I've seen are disappointing.  They're usually an aesthetic improvement over the "before," but the scars are often unsightly, the nipples distorted, and the counters of the chest and area under the arm pits still off.
I'm impressed by the photographs in Hurwitz's article and in his book (most can be seen on his website).  The scar is in the middle of the chest instead of at the inframammary crease, but I think the counter of the chest achieved is better (at least in the after images that he's shown).  
But when I've gone to consults in the New York area with reputable plastic surgeons, not a single one said he performs that procedure, and they all seemed skeptical of it.  Frankly, I'd be happy to go to Pittsburgh for a good aesthetic result, but I'm a little worried that so few surgeons perform this procedure.  
My question is, why?

[Litlriki]

There are multiple approaches to skin resection after massive weight loss, including Dr. Hurwitz's approach. Surgeons who do a lot of this sort of surgery tend to develop an approach, which they find most effective in achieving their best results.  When you seek consultation, it's best to view photos, as you've described, to find results which are pleasing to you.  That's no guarantee that you will get those same results, but it will at least give you a sense of the sort of improvement you can get. If Dr. Hurwitz's photos demonstrate the sort of results you're looking for, and if you're able to go for a consultation, it would certainly be worth your while.  I've seen his presentations at meetings and his results for massive weight loss patients are very good, consistent with his center's extensive experience. 

[DrPensler]

There are essentially two ellipses of skin that need to be removed when there is massive weight loss. There is a vertical skin reduction and a horizontal skin reduction that needs to be accomplished. The amount of skin to be resected varies in each case. In addition the nipple areolar complex typically needs to be re-positioned. A boomerang scar seems to me the worst of all possibilities to accomplish this in that you have a very long and visible scar that does not have as much control as a wise pattern.Also it does not afford the opportunity to reposition the nipple superiorly with minimal scar which in my experience is almost always required. I would also caution you to look carefully at the results of this or any type of extensive excision. The view should be straight ahead from the front with the arms at the side for evaluation. A side view with the arms elevated or partially elevated is typically done to obscure a sub-optimal result. Any correction after massive weight loss is difficult and often needs revision surgery to truly optimize the final result. Also when there is a technique that has been around for  long time in a common clinical situation that has not gained any significant traction there is usually a reason for this. Finally correction after massive weight loss say 180 lbs and up are more of a body lift than gynecomastia correction.

[Dr. Elliot Jacobs]

I concur with both Drs Silverman and Pensler.  If you like the results of Dr Hurwitz's work, then it is certainly worth a consultation.

However, to put it into perspective, while there are many techniques to achieve a similar contour, some techniques are much more popular (and used by many more surgeons) than others.  The classic mastectomy with a scar in the infra-mammary fold (which fades and looks like a normal part of the chest anatomy) and a free nipple graft (which allows placement of the nipple on any part of the chest) is my choice -- and the choice of many many surgeons around the globe.

Dr Jacobs