skin reduction

[paulo]

hi guys,

any of you had excess skin removed along with the gyno?

ive sent pics to a surgeon and he said if he removes skin ill be left with ankor like scars under the breasts.......?

is this how they normally do it?

[BMB65]

yes , thats how it was explained to me ....im probably a canidate for skin removal but im gonna ride it out being that i go to the gym all the time ....that will give me the motivation to work harder ....plus they say you may not see your final results for 8 months to a year

[DrBermant]

hi guys,

any of you had excess skin removed along with the gyno?

ive sent pics to a surgeon and he said if he removes skin ill be left with ankor like scars under the breasts.......?

is this how they normally do it?

I do not need to use a skin reduction technique for almost any of my normal Gynecomastia Male Breast Enlargement patients.

However, the male chest can be distorted by Drooping or Ptosis after massive weight loss or deflation of massive muscles.   

Posting Standard Pictures to Show Male Chest Drooping after weight loss can help others better understand if the loose skin component is a factor.

Low areola and sagging skin do not give a good contour to the male chest.  Surgery to deal with both the residual contours of gynecomastia and loose hanging tissues can be combined.  Male Mastopexy Chest Lift for Drooping Chest or Ptosis can consist of many different Surgical Options for Excess Skin of the Male Chest.  A Short Scar Skin Reduction Chest Lift hides the scars under the pectoral muscles and around the areola.  Anchor scars just do not look good on the chest, either male or female.

Hope this helps,

Michael Bermant, MD
Learn More About Male Mastopexy Chest Lift for Sagging Tissues

[Dr. Elliot Jacobs]

For most young men whose breasts are of moderate size and have never been significantly overweight, the skin will tighten sufficiently by itself to negate the need for direct skin tightening. Thus I do most of my procedures with the most minimum of scars. And in some patients in whom there may appear to be excess skin, I would still opt NOT to excise skin at the same time.  Remember, any skin incision will leave permanent scars on the chest.

In many cases in which there appears to be lots of excess skin, one would be surprised at how much skin tightening occurs spontaneously.  And if there is a little lax skin left over 6 or 8 months after the initial surgery, one can then go back and remove the remaining (and smaller amount) excess skin with much smaller incisions and resultant scars.

Finally, in some very tough cases in which there is no choice except to do a primary skin removal, there are other ways to do it without the classic anchor scars (which are more appropriate for female breast reduction).  Breast reduction in a male should be approached differently than breast reduction in a female.

Dr Jacobs

[legalman]

Dr. Jacobs, can you elaborate on how differently a male breast reduction should be performed? I have consulted recently with three surgeons and have received very different opinions from each of them. I am 28, have been in great shape for the past 10 years, although prior to that I was significantly obese. I currently have stage III/IV gyno with severe ptosis and excessive skin.

The first surgeon was conservative, and after examining my photos he suggested only excision and lipo. The second surgeon had no idea what to do other than excision. The third surgeon described a procedure that, in addition to excision and lipo, involved an incision (he used a word that sounded like pedicure...) around the areola and repositioning of the nipple. In addition, he described a comma shaped incision coming off of the bottom of the nipple as part of the skin reduction technique.

I will probably undergo this last surgeon's recommended surgery. Has anybody else had (or performed) a similar procedure? Is there a preferable procedure, or is this generally considered the best option for a case such as mine?

[Grandpa Bambu]

I currently have stage III/IV gyno.

What is 'Stage III/IV Gynecomasita'?  I have never heard of that before...

Post a few pics of your G dude...

GB...

[Dr. Elliot Jacobs]

Legalman

From what you describe (no photos have been provided) and assuming you are in shape now (I presume a normal BMI), then there is a point where a surgeon would not anticipate sufficient spontaneous skin tightening.  In these cases, primary removal of excessive skin and re-positioning of the nipple is the best way to go (obviously, there will be removal of excess fat and gland as well).  Each case is different, depending upon where the excess skin has collected.  And surgery to remove your gyne and tighten the skin will result in more scars than a standard approach.  However, the final result -- a trim, taut, contoured chest -- may be worth the scars (always a trade-off).  The scars themselves will fade over time.

Please see patient 46 a/b for an example of what I am talking about.

Dr Jacobs

[Dr. Elliot Jacobs]

Sorry, forgot to give you the URL: 

http://www.gynecomastianewyork.com/photo.asp  then see patient 46a/b

Dr Jacobs

[legalman]

just wanted to post a link to my pics. only have one up atm.

http://www.gynecomastia.org/smf/index.php?topic=17802.0

[Dr. Elliot Jacobs]

Thanks for the photo.  I did two cases like you this week.

My over-riding concern in approaching gyne surgery is to minimize scars and maximize the results.  Sometimes, in an effort to minimize scars, one needs to settle for an 85-90% improvement, instead of 100%.

Your case is honestly borderline -- with a problem of asymmetry to boot (your right breast is larger and more droopy than the left).  However, I do try an aggressive approach with minimal scars on patients such as yourself with the mutual understanding that some, but not all, of the skin will spontaneously tighten.  You will undoubtedly have some residual laxity, which will take the form of a residual fold under the breast.  And minimal scar techniques do not allow for improvement in the asymmetries between the two breasts.  On the other hand, you would have avoided a significantly longer operation with major permanent scars on your chest.  And, 6-8 months after minimal scar surgery, if you still have some objectionable skin laxity, you can have a much more limited skin removal surgery (which can make the nipples more symmetric as well).  This would leave smaller scars than you would have had in the original surgery.

Dr Jacobs

[DrBermant]

I have consulted recently with three surgeons and have received very different opinions from each of them. I am 28, have been in great shape for the past 10 years, although prior to that I was significantly obese. I currently have stage III/IV gyno with severe ptosis and excessive skin.

The first surgeon was conservative, and after examining my photos he suggested only excision and lipo. The second surgeon had no idea what to do other than excision. The third surgeon described a procedure that, in addition to excision and lipo, involved an incision (he used a word that sounded like pedicure...) around the areola and repositioning of the nipple. In addition, he described a comma shaped incision coming off of the bottom of the nipple as part of the skin reduction technique.

I will probably undergo this last surgeon's recommended surgery. Has anybody else had (or performed) a similar procedure? Is there a preferable procedure, or is this generally considered the best option for a case such as mine?

There can be a great deal of loose hanging skin After Major Weight Loss.  Such skin may have very little elasticity and tends not to shrink well after surgical reduction. 

Options for this problem are a compromise:

• Live with the excessive weight: Bad for your health.
• Male Mastopexy Chest Lift: Skin reduction scars are a compromise, but can be quite reasonable as demonstrated on the many examples I have posted.
• Low Male Nipples Areola: Reduction without lift can still leave the loose skin and low areola.  Check out this drawing to see how weird low nipples look on the male chest.
• Body Shaping Garments - contouring without surgery.

A single picture does not really tell the story about how much is the loose skin a factor.  That is why I evolved my Standard Pictures to evalute loose skin of the male chest and sagging breasts in men.

I prefer to individualize each surgical sculpture based on the problem to be treated.  The best surgery minimizes scars.  This is not just the incisions, but the entire sculpted surface.  The chest should also look good in motion, not just a few pictures at selected angles. Sometimes leaving loose skin is a good compromise.  At other times the scars from a skin reduction are a much better choice.  The actual choice for skin reduction incision is quite different for men than women.  A scar beyond the areola is not well hidden on a contoured male chest unless it is hidden in the natural crease of the pectoral muscle as in thisSkin Reduction Chest Lift.  Some patients have skin quality good enough for my Short Scar Internal Male Chest Lift Surgery.

Here are several examples of patients with various degrees of loose skin after weight loss and compromises performed.

Short Scar Internal Chest Lift After Weight Loss

Short Scar Male Chest Lift

Male Breast Lift (Internal)

Short Scar Male Chest Lift

Skin Reduction Male Chest Lift

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia of Male Chest Ptosis - Sagging and Male Mastopexy Chest Lift Sculpture