Had Gynecomastia Excision + Lipo - 5 Days Post-Op - Will I see improvement?

[ContinentalOp128]

5 days ago I underwent a lower body lift and gynecomastia (excision and lipo) on both breasts. My lower body is looking much better, and I can see improvement. I don't feel the same way about my breasts/upper chest area, though. I understand that they may still be swollen, but I'm not sure that's the case, and I'm worried.
I had lost about 110 lbs., through diet and exercise, a few years ago, reaching a healthy weight (I'm now 6'0, ~170, 21yr old male). I had a ton of extra skin and fat around my breasts and lower body, and eventually turned to surgery when I could do no more naturally.
It is now 5 days post-op. My breasts are still noticeably large and somewhat saggy & low-hanging. They do look better than they did pre-op, but they are still enlarged, fatty (or what feels like fattiness), and ugly. Some photos below.
Is it likely that the coming weeks will see significant improvement (I read that results are mostly immediate with gynecomastia surgery)?
I understand they won't look perfect, but I'm hoping to, for example, be able to be ok taking my shirt off in public.
My surgeon said we could do a touch-up, so I'm hoping that with that they'll improve, but I don't know. Any thoughts?
I was planning to bulk up and build muscle in the coming months - would that have the effect of improving them?

[Dr. Elliot Jacobs]

Congratulations on your weight loss -- you are now much healthier!  Unfortunately, however, the extra weight contributed to a loss of elasticity of your skin -- that it why your lower body was drooping and you needed a lower body lift.

The same holds true for your chest -- that skin has been stretched and has lost elasticity.  While I have no idea of what you looked like pre-operatively, your immediate post op photo reveals some skin redundancy which I doubt will spontaneously tighten over time.  Your surgeon may have been trying to spare you some additional scarring on the chest -- but only time will tell.

My educated guess is that in six months you will still have some residual tissue and lax skin, thereby depriving you of a trim, taut, contoured chest.  In order to achieve that type of chest, you will probably require some type of skin excision/tightening -- which will leave scars as a trade-off.

I think you should inform your surgeon of your concerns and of course give your chest time to heal -- you may end up with something which, perhaps not perfect, might be something you could live with -- and without further scarring.

Best of luck to you!

Dr Jacobs

[ContinentalOp128]

Thank you very much. I suspect that is what my surgeon meant by performing a touch up in the coming months. Do you think my situation would be improved by building muscle in that area?
Any other opinions are likewise appreciated.

[Dr. Elliot Jacobs]

If you build muscle, it will push whatever tissue is on your chest even further out -- and that tissue will continue the mask the contours of the muscle itself.  The only time building muscle might help a bit is if you have some lax skin with minimal thickness of tissue on the chest.  Then, building muscle may take up some of the slack of the lax chest skin.

In your case, I believe there is just too much tissue and skin for muscle building to do much good in that regard.  But body toning in general is a good thing -- don't neglect it.  And when you do have some revision in the future, then your (new) muscles will be revealed.

Dr Jacobs

[DrBermant]

5 days ago I underwent a lower body lift and gynecomastia (excision and lipo) on both breasts. My lower body is looking much better, and I can see improvement. I don't feel the same way about my breasts/upper chest area, though. I understand that they may still be swollen, but I'm not sure that's the case, and I'm worried.
I had lost about 110 lbs., through diet and exercise, a few years ago, reaching a healthy weight (I'm now 6'0, ~170, 21yr old male). I had a ton of extra skin and fat around my breasts and lower body, and eventually turned to surgery when I could do no more naturally.
It is now 5 days post-op. My breasts are still noticeably large and somewhat saggy & low-hanging. They do look better than they did pre-op, but they are still enlarged, fatty (or what feels like fattiness), and ugly. Some photos below.
Is it likely that the coming weeks will see significant improvement (I read that results are mostly immediate with gynecomastia surgery)?
I understand they won't look perfect, but I'm hoping to, for example, be able to be ok taking my shirt off in public.
My surgeon said we could do a touch-up, so I'm hoping that with that they'll improve, but I don't know. Any thoughts?
I was planning to bulk up and build muscle in the coming months - would that have the effect of improving them?

Congratulations on your weight loss!  Does it not feel much better with that weight off?  110 pounds is an amazing amount of tissue.

After Major Weight Loss skin and supporting tissues retract only so much leaving sagging and drooping.  These are usually global factors affecting most regions of the body.  For men, the sagging chest is often the biggest concern.  However, there are often issues of the stomach, thighs, buttocks, arms, and more.  While a Tummy Tuck Abdominoplasty can help with the front, a Lower Body Lift helps deal with the stomach, thighs, and buttock sagging. 

Low Nipples Do Not Look Good on the Male Chest. Unless this excess tissue is removed, the excess skin can contribute to a contour problem and fold. You can see early results after surgery that addresses the skin problem on my website. 

Excess Skin of the Male Chest with Gynecomastia comes in various degrees.  Here are my Standard Pictures for Evaluating Extra Skin on the Male Chest.

Weight loss and surgical sculpture is a series of compromises. What suites any one individual will vary.  Ideal sequence that I recommend my patients:

• Get to a weight you are comfortable living with.
• Let the skin adjust as much as it will. It can take from 6 to 18 months for skin equilibration after a gastric bypass and major weight loss.
• Consider Tightening Lower Tissues First. There is little sense to lift the chest and then have a tummy tuck, lower the chest result, requiring a revision chest lift.
• Then Address the Chest.
• Use No Surgery Body Shaping Garments as emotional support not to rush the process.

For some patients, my small incision skin reduction chest lift is an option.  This eliminates the unnatural very obvious unnatural vertical scar.  For smaller problems, I have evolved my Internal Lift Male Mastopexy Surgery that has even smaller scars.  My internal lift is not suitable when the excess skin is a major contributing factor for the deformity.  A Male Donut Mastopexy when pushed too far will leave a star burst deformity that detracts from the result. That is why picking your surgeon carefully can be so important.

Yes, scars are a compromise.  We need some place to remove the excess skin.  The shorter the scars, the less skin that is removed. 

Do you think my situation would be improved by building muscle in that area?
Any other opinions are likewise appreciated.

It can take a massive amount of bodybuilding to build enough muscle to fill a major loose skin envelope. Keeping that extra muscle can take a great deal of work. Once that muscle shrinks, a loose skin envelope can distort the look of the chest.

Options are best explored during an evaluation.

Hope this helps,

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