Correct Procedure / Weight Concerns

[superhuman]

I have ultimately only two concerns left, and would love alternative opinion from the different supporting doctors here.

Procedure concern...

I was told from one surgeon that I would need the following procedure done:

- lipo
- excision
- donut procedure

I understand in my case, I definently want lipo and excision done... but now I also have to be concerned about donut since it was mentioned.

Another surgeon said he would only like to do lipo and excision... see how the results go and 6 months down the road then see if the donut procedure is needed as it may affect different results. The primary reason why this donut procedure was mentioned is due to my skin elasticity. I agree I don't have the best looking skin, as I do have a few stretch marks maybe because I had lost weight from before I'm not too sure. Therefore, the doc said for a better result he would like to do the donut procedure as well so he can retract the skin etc etc.

Question: Do you think I would need to have the donut procedure done during the same time as lipo/excision.. or is it better to get it done after?


Weight Concerns

I calculated myself and I came up to be 26.5 which is put in the overweight category, although If I lose 10 pounds im back into the normal weight category. I admit I do have a gut... like a beer belly but not even a big one just a normal in a shirt I don't look fat just a bit chubby I guess?

My question is.... Do you think me getting surgery done at this weight will affect the results in any  way and differ if I wouldve gotten the surgery done if i lost 10-15 more pounds?....

[DrBermant]

I have ultimately only two concerns left, and would love alternative opinion from the different supporting doctors here.

Procedure concern...

I was told from one surgeon that I would need the following procedure done:

- lipo
- excision
- donut procedure

I understand in my case, I definently want lipo and excision done... but now I also have to be concerned about donut since it was mentioned.

Another surgeon said he would only like to do lipo and excision... see how the results go and 6 months down the road then see if the donut procedure is needed as it may affect different results. The primary reason why this donut procedure was mentioned is due to my skin elasticity. I agree I don't have the best looking skin, as I do have a few stretch marks maybe because I had lost weight from before I'm not too sure. Therefore, the doc said for a better result he would like to do the donut procedure as well so he can retract the skin etc etc.

Question: Do you think I would need to have the donut procedure done during the same time as lipo/excision.. or is it better to get it done after?


Weight Concerns

I calculated myself and I came up to be 26.5 which is put in the overweight category, although If I lose 10 pounds im back into the normal weight category. I admit I do have a gut... like a beer belly but not even a big one just a normal in a shirt I don't look fat just a bit chubby I guess?

My question is.... Do you think me getting surgery done at this weight will affect the results in any  way and differ if I wouldve gotten the surgery done if i lost 10-15 more pounds?....

In general weight loss before surgery is better than after. Losing weight is a coarse tool, you cannot pick where the weight comes from. Tighten or lift the chest, and then lose weight, what makes you think your skin will then tighten with the additional loss?  When sagging tissues or tightening are contour concerns, the timing of weight loss are even more critical for optimal results unless you do not mind the need and paying for revision gynecomastia surgery.

Male Donut Mastopexy is it's own unique sculpture, totally different than the surgery in women due to the flat chest and small areola diameter. Without permanent mechanisms to overcome the forces pulling the areola to a larger size, Massive Areola Diameter Complication in men occurs.  Unfortunately, I have seen too many such disasters from doctors who did not understand such forces leaving their patients disfigured as demonstrated in that example. I rarely need such skin reduction options for my patients. The exceptions are Male Mastopexy after Massive Weight Loss and Female to Male Top Surgery where there is just too much skin to overcome for a decent chest contour. In such cases I tend to use a Skin Reduction Chest Lift instead when I cannot get away with the much smaller scars of my Internal Male Mastopexy Chest Lift.

Look for actual examples of a surgeon's skill with male chest tightening contour operations before selecting them for this sculpture. Again, this is not the same as female breast surgery.

Hope this helps,

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

[Dr. Elliot Jacobs]

Obviously, the best surgical results occur when you are at your lowest and most stable weight.  If that difference for you is only ten pounds, however, then the effect of weight loss would be minimal.

Your surgeon plans to do lipo and possibly excision -- great.  Whether to do a donut excision or not at the end of the procedure?  My gut feeling is to wait and see.  Skin, even when there may be some diminished elasticity, still retains some ability to tighten.  And donut scars tend to spread apart (become wide) or to stretch the areola, both of which are not appealing.  Waiting for six months or more after surgery will give your own innate skin tightening ability to work.  And then, if indeed something should be done, you will undoubtedly have less extra skin to deal with -- which means less scars.

Something to consider:  a nicely contoured chest with minimal scars and a 90% result may be better than a perfectly contoured 100% chest with noticeable scars.

Dr Jacobs

[superhuman]

Thanks for your kind replies.... but the donut lift that will be done isn't the whole process. Meaning, do you know when people absolutely dont have no other choice but to do the donut lift therefore a lot of the donut lift is needed just to make the results better. In my case, I was told the donut lift will be so minimum where no changes to the areola will be made, and even scars would be so minimal as they would fade away just because it will be so minimal. I believe in what the surgeon was saying even though many others dont agree, but I trust him since he is looking at me as a 'future person'... normally a lot of people that get their lipo/excisson sometimes have to get a revision where a donut lift is necessary.

What are your thoughts?

[Dr. Elliot Jacobs]

Obviously, the surgeon you consulted has the advantage of having examined you in person.  If it is his professional opinion to proceed with the donut excision and you have faith and trust in him, then go for it!!

Dr Jacobs

[DrBermant]

Thanks for your kind replies.... but the donut lift that will be done isn't the whole process. Meaning, do you know when people absolutely dont have no other choice but to do the donut lift therefore a lot of the donut lift is needed just to make the results better. In my case, I was told the donut lift will be so minimum where no changes to the areola will be made, and even scars would be so minimal as they would fade away just because it will be so minimal. I believe in what the surgeon was saying even though many others dont agree, but I trust him since he is looking at me as a 'future person'... normally a lot of people that get their lipo/excisson sometimes have to get a revision where a donut lift is necessary.

What are your thoughts?

There is a gentle transition zone of color change of the areola to chest skin interface that is destroyed with any donut lift by design. For any subtle problem only needing a small skin reduction, the sacrifice of this transition zone does not look good but nor does a scar extending around the entire areola. In my opinion, that is a trade off I am not willing to offer my patients. I just do not like the way it looks. If you have actually seen such examples of men with donut areola reduction from your surgeon that you like, then it may be worthwhile. But for myself, I have not. I have seen many disasters with patients coming to me unhappy after such decisions with other doctors. I have yet needed to perform a secondary skin reduction lift on one of my own patients who had the issues of compromises before surgery explained as part of their teaching experience and decision making before surgery.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery