Horizontal incisions?

[scurlaruntings]

Hi

I have lipomastia because I've lost 130 pounds.
Photos:
  


I've recently been to a plastic surgery clinic, who has booked me for surgery in a couple of weeks. They plan to do a liposuction and move the nipples. In doing so, they will make horizontal incisions. 
The plastic surgeons have given me this post-surgery example photo:


I worry that the scarring will make me feel just as bad (if not worse). I've read an article by Dr. Miguel Delgado, who considers this surgery method unacceptable.

However, the plastic surgeons say I have no other options, because the skin is too loose and the nipples are out of position.

I would greatly appreciate some advice.

[Miguel Delgado MD]

Scurlaruntings,
This type of case is difficult and you do have skin laxity but you are still a grade 2 gynecomastia. The skin is not hanging over the fold.  I agree about the scar and it is significant but will heal and blend in overtime but the scar may prevent you from taking off your shirt.  I would approach this differently and I assume you are fairly young.  In my hands, I would suggest a standard gland excision, liposuction with the incision from 3 to 9 o'clock. In addition, I would add heat to the skin underneath for added contraction of the skin.  The second stage in 4-6 months, if needed would be a peri-areolar lift which results in an incision around the areola cutting out a donut of skin and a  purse-string closure. Often the second stage is not needed. There are examples of the 2-stage procedure on my websites.

I have done many of the double incision with a free nipple graft and this is a great procedure.  The skin is very tight and the areola is resized smaller.  I have had 100% satisfaction with patients with this technique which is rare to say in surgery. However. there is a long incision which some men use artistic tattoos to cover.

[scurlaruntings]

Scurlaruntings,
This type of case is difficult and you do have skin laxity but you are still a grade 2 gynecomastia. The skin is not hanging over the fold.  I agree about the scar and it is significant but will heal and blend in overtime but the scar may prevent you from taking off your shirt.  I would approach this differently and I assume you are fairly young.  In my hands, I would suggest a standard gland excision, liposuction with the incision from 3 to 9 o'clock. In addition, I would add heat to the skin underneath for added contraction of the skin.  The second stage in 4-6 months, if needed would be a peri-areolar lift which results in an incision around the areola cutting out a donut of skin and a  purse-string closure. Often the second stage is not needed. There are examples of the 2-stage procedure on my websites.

I have done many of the double incision with a free nipple graft and this is a great procedure.  The skin is very tight and the areola is resized smaller.  I have had 100% satisfaction with patients with this technique which is rare to say in surgery. However. there is a long incision which some men use artistic tattoos to cover.

Dear Dr. Delgado

Thank you so much for your response.

You're right. I'm in my late twenties.

As I understand you, a long incision is unavoidable in my case, but if heat contracts the skin to a sufficient degree, then it might not be necessary to do anything about the nipples.
Otherwise, it would be a good idea to do a peri-areolar lift as you described, which I assume is unrelated to a free nipple graft.

Also, do you know if the techniques you described are common amongst plastic surgeons? Particularly adding heat for contraction and the 2-stage procedure. 
It seems like it may be worth finding another plastic surgeon who has experience with those techniques.

[Miguel Delgado MD]

Sorry if I was confusing; I do not think that you require a double incision in my hands.  I described what I would do. I was only explaining that it is a good procedure, in general, but the big down-side is the scar. The heat is unpredictable but helpful in some cases.  There are other techniques that I do in these cases and a doctor's experience is key. You can not do the peri-areola lift at the same time as the gland excision. It is hard to say who regularly performs these procedures.  The lift should be done with a Gortex suture and a "wheel suture" technique. This prevents the scar from spreading. Good luck.

[Dr. Elliot Jacobs]

I would agree with Dr Delgado. There is no clear cut correct answer for your problem.  But you are young and I would assume your skin has retained at least some of its elasticity despite your prior overweight condition -- and that would help the skin to tighten and the nipple to self elevate if you had a minimal scar type of surgery (with an incision at the lower edge of the areola).

I hate putting large scars on men -- the results might be a tight chest but the scars themselves are permanent.  I only use the double incision surgery with nipple grafts in extreme cases.

In cases such as yours, liposuction and gland excision through minimal scars could probably provide a very reasonable result.  I too, like Dr Delgado, will offer a second lift of the nipple if needed -- but only after 6 - 12 months of healing.  And most often, that second stage lift isn't needed.

Good luck -- and find an expert gyne surgeon!

Dr Jacobs

[scurlaruntings]

Dr. Delgado and Dr. Jacobs, I am deeply grateful for your responses. Thank you.

I will definitely cancel the planned surgery and find an expert gyne surgeon instead. It is clear that the surgeons I consulted with know little about gynecomastia, and they opt for easier, one-size-fits-all surgery techniques. In my case, it would only cause more distress.

[Dr. Schuster]

I refer to this procedure as a nipple graft technique and it is a good operation. I always discuss the scars and it is the main thing that patients have to consider. It is a trade off operation. The scar generally continues to fade over a year or so and ihas been acceptable to all of my patients that have had this done. It ultimately depends on your priorities. The flatter and tighter you want the results to be will require more skin to be removed and result in more scars.