I'm in a dilemma: When is it most ideal to opt for surgery?

[intheuniverse]

I've read through many threads throughout this forum. They are very thoughtful and informative. I appreciate everything everyone has contributed as it certainly makes those who haven't had the surgery feel less anxious about it.

The question for me now isn't about whether or not I will get the surgery, but rather when would it be most ideal to do so? I was 230 lbs last year, and through diet and exercise I have brought it down to 165 lbs. I'm 5 feet 10. My current BMI is 24. I carry 21% body fat. Most of my current body fat resides on my stomach and chest.

The ideal physique I would like to strive for is a defined body with a lower body fat percentage, say 10%; nice chest and stomach. I have read from others who've stated that the doctor doesn't remove all chest fat unless your weight is at a good level, otherwise he just wants to make it proportionate to your current body - and will keep some fat on the chest.

If I were to get the surgery today, I am fearful that when I do reach that goal of say 10% body fat, the chest will still carry some fat on it despite my additional body weight loss.

So the question I have now is: Is my fear well-placed -- if I get the surgery now, can I still be just as optimistic about reaching my goal of having a defined chest as it would be if I were to wait to get to that level first (of 10% body fat) before opting for the surgery?

[Grandpa Bambu]

Congratulations on your weight loss my man...

You say you are 5'10" at 165? Dude, you have nothing to worry about. You can have the surgery anytime.

This is the first that I've heard that surgeons perform surgery proportionately. I was 196 lbs. standing at 6' when I had my surgery, and am to this day (over 5 years later) very happy with surgery results. 

Git'er Done!!!

GB...

[Dr. Elliot Jacobs]

I second Grandpa Bambu.  Congrats on your weight loss -- nearly 28% of your original body weight.  Your BMI is now about 23.7 -- very healthy -- keep it that way.

Setting a goal of 10% body fat may be unrealistic and unattainable -- it takes true determination and strenuous workouts to build muscle and reduce body fat to those levels -- something that most guys cannot do and which takes up an inordinate amount of time.

In terms of surgery -- you are ready now.  But you must also understand that such weight loss usually reveals stretched out skin due to loss of elasticity.  Thus any surgery may require more than the minimal incision surgery that is used for most gyne procedures.  You may require not only removal of residual chest tissue, but removal of stretched out skin and re-positioning of the nipple to a more normal location.  This will result in additional scars -- but they will be a trade-off for a trimmer and more comfortable shape.  And scars fade.

You should absolutely consult several plastic surgeons who are experienced in gyne surgery.

Best of luck!

Dr Jacobs

[Grandpa Bambu]

In terms of surgery -- you are ready now.  But you must also understand that such weight loss usually reveals stretched out skin due to loss of elasticity.  Thus any surgery may require more than the minimal incision surgery that is used for most gyne procedures.  You may require not only removal of residual chest tissue, but removal of stretched out skin and re-positioning of the nipple to a more normal location.  This will result in additional scars -- but they will be a trade-off for a trimmer and more comfortable shape. 

Dr Jacobs

Doc J...

As a percentage, how many of your G patients require skin tightening and areola/nipple relocation?

I had 'D-cups' and did not require any other procedures other than the original excision and lipo.

GB...

[Dr. Elliot Jacobs]

Very few patients require skin excision and nipple re-location.  I have a technique which encourages skin tightening.  Overall, my guess is maybe 2-3%.

Dr Jacobs

[DrBermant]

I've read through many threads throughout this forum. They are very thoughtful and informative. I appreciate everything everyone has contributed as it certainly makes those who haven't had the surgery feel less anxious about it.

The question for me now isn't about whether or not I will get the surgery, but rather when would it be most ideal to do so? I was 230 lbs last year, and through diet and exercise I have brought it down to 165 lbs. I'm 5 feet 10. My current BMI is 24. I carry 21% body fat. Most of my current body fat resides on my stomach and chest.

The ideal physique I would like to strive for is a defined body with a lower body fat percentage, say 10%; nice chest and stomach. I have read from others who've stated that the doctor doesn't remove all chest fat unless your weight is at a good level, otherwise he just wants to make it proportionate to your current body - and will keep some fat on the chest.

If I were to get the surgery today, I am fearful that when I do reach that goal of say 10% body fat, the chest will still carry some fat on it despite my additional body weight loss.

So the question I have now is: Is my fear well-placed -- if I get the surgery now, can I still be just as optimistic about reaching my goal of having a defined chest as it would be if I were to wait to get to that level first (of 10% body fat) before opting for the surgery?

Congratulations on the weight loss! Does it not feel great getting that extra mass off of your body? 

We each have comfort levels of what fat we like to carry around. As I have been explaining for years on this forum, normally weight loss before surgery is better than weight loss after. The exception is for those going down to exceptionally low body fat levels. For those marathon runners, athletes, and Bodybuilders with Gynecomastia, I prefer to work on their off season body fat levels. Get the fat too low and the body starts acting strangely: women lose their menstrual cycles, healing can be impaired, and other strange things can happen. Check out that last link to see what I mean. My before and after surgery pictures were not at his competition body fat. Having some fat provides a resource for reconstruction such as my Fat Flap Sculpture. With that much weight loss, loose skin can also be a factor.

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.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[robos111]

"intheuniverse" , question.

I am in a similar case to yours. I was 238 plbs and 38% body fat.
Now, 14 months later, with diet and excercise, I am 189plbs and 20% body fat. I have only noticed a very slight (at best) improvment on my chest area. I was also hoping to get down to somthing like 13% body fat before surgery.
Has your chest become any smaller with the weight loss?
Do you feel that if you get it down to 10% body fat that there may be a chance that the chest will look more normal?
This is kind of what I was hoping for (even though I realize that there will be little chance)
thanks,
Robos

[intheuniverse]

"intheuniverse" , question.

I am in a similar case to yours. I was 238 plbs and 38% body fat.
Now, 14 months later, with diet and excercise, I am 189plbs and 20% body fat. I have only noticed a very slight (at best) improvment on my chest area. I was also hoping to get down to somthing like 13% body fat before surgery.
Has your chest become any smaller with the weight loss?
Do you feel that if you get it down to 10% body fat that there may be a chance that the chest will look more normal?
This is kind of what I was hoping for (even though I realize that there will be little chance)
thanks,
Robos

Chest is somewhat smaller now, but not as much as I would have liked it to be. Strangely now, my stomach doesn't stick out as much as my chest does (unless I eat a big meal). I also carry a little more muscle under the chest due to my workouts, and the added muscle I feel only contributes to the 'sticking-out' appearance.

"Do you feel that if you get it down to 10% body fat that there may be a chance that the chest will look more normal?
This is kind of what I was hoping for (even though I realize that there will be little chance)"

I would like to hope so; no idea, though.