So I'm schedule for surgery... Just one small problem.

[qwop]

Hello, I've browsed around here before, but never registered until now, so I'm new-ish here 

My breasts are the result of loose skin leftover from childhood obesity, rather than a medical condition, so there is no excess breast tissue, just loose skin and perhaps a bit of leftover body fat that my body has hung onto. I am currently at and have maintained for years, a normal weight.

So I've found a surgeon who was recommended to me, has good credentials, works with a hospital, and who has 20+ years of experience, and I'm scheduled to have an abdominoplasty and male breast reduction. I'm feeling quite confident and excited about the surgery, and of course a little nervous, which I think is normal (I've never had surgery in my life).

The one problem is that the surgeon has explained the different ways breast reduction can be performed (donut cut, cut with vertical incision, or cut with 'anchor' incision). We had a fairly long discussion where he explained that I'm basically trading more scarring for more freedom to remove skin, and that the donut cut will leave the least scarring which may even be inconspicuous enough to go unnoticed by others. But he's left me with the decision to make.

It seems a lot of people set the bar for results at how good you'll look shirtless. Honestly my expectations for surgery are lower than that. I just want to at least feel comfortable wearing a t-shirt. That would make a world of difference to me. I've been self-conscious about taking my shirt off in public since I was about 5 years old, and I'm now 21, so I guess it's sort of a "you wont miss what you never had" compromise. I mean let's face it, flatter stomach or not, it wont help much if I still have breasts.

I did explain this to my surgeon, but he didn't immediately say "go with the bigger scars then". Instead he actually brought up liposuction in combination with the donut incision as a way of trying to achieve flatness. But he added that it was my choice, and since results can be unpredictable he couldn't tell me whether this approach would actually achieve what I wanted or not. He merely said that with the longer cut, he has the freedom to take more skin, but the scars would be considerably more noticeable.

So I've got a lot to weigh and consider here... I mean the thought of being able to see myself without the breasts OR the large obvious scars would be so amazing I can't even think of a suitable simile, and I did pretty well in English.

Obviously I don't expect any of you to know what the outcome of the procedure would be for me. But any comments or considerations. Or maybe links or other resources that might help me decide?

I mean... I don't think the surgeon would be telling me to take time to think about it if he didn't think there was much chance of it achieving the desired results, right? Or maybe I'm getting greedy and this is too good to be true?

Thank you in advance for your time and consideration.

[Dr. Elliot Jacobs]

Why not post a series of chest photos (different angles, etc) taken by another person (so that your chest is not distorted)?  We will then, perhaps, be able to make some constructive comments for you.

Dr JAcobs

[qwop]

There was a guide by Dr. Bermant which detailed which angles to photograph. I followed his guide located on his website. I also tried to resize them so they would fit nicely on the forum. If any of the pictures are inadequate or too small, or if you otherwise feel more photographs necessary, I am always capable of resizing, taking, or retaking photographs.

Frontal


Frontal with arms raised


Frontal with hands on hips


Frontal with hands on hips, flexed


Left side


Left oblique


Right side


Right oblique


Once again, thank you for your time.

[DrBermant]

Hello, I've browsed around here before, but never registered until now, so I'm new-ish here 

My breasts are the result of loose skin leftover from childhood obesity, rather than a medical condition, so there is no excess breast tissue, just loose skin and perhaps a bit of leftover body fat that my body has hung onto. I am currently at and have maintained for years, a normal weight.

So I've found a surgeon who was recommended to me, has good credentials, works with a hospital, and who has 20+ years of experience, and I'm scheduled to have an abdominoplasty and male breast reduction. I'm feeling quite confident and excited about the surgery, and of course a little nervous, which I think is normal (I've never had surgery in my life).

The one problem is that the surgeon has explained the different ways breast reduction can be performed (donut cut, cut with vertical incision, or cut with 'anchor' incision). We had a fairly long discussion where he explained that I'm basically trading more scarring for more freedom to remove skin, and that the donut cut will leave the least scarring which may even be inconspicuous enough to go unnoticed by others. But he's left me with the decision to make.

It seems a lot of people set the bar for results at how good you'll look shirtless. Honestly my expectations for surgery are lower than that. I just want to at least feel comfortable wearing a t-shirt. That would make a world of difference to me. I've been self-conscious about taking my shirt off in public since I was about 5 years old, and I'm now 21, so I guess it's sort of a "you wont miss what you never had" compromise. I mean let's face it, flatter stomach or not, it wont help much if I still have breasts.

I did explain this to my surgeon, but he didn't immediately say "go with the bigger scars then". Instead he actually brought up liposuction in combination with the donut incision as a way of trying to achieve flatness. But he added that it was my choice, and since results can be unpredictable he couldn't tell me whether this approach would actually achieve what I wanted or not. He merely said that with the longer cut, he has the freedom to take more skin, but the scars would be considerably more noticeable.

So I've got a lot to weigh and consider here... I mean the thought of being able to see myself without the breasts OR the large obvious scars would be so amazing I can't even think of a suitable simile, and I did pretty well in English.

Obviously I don't expect any of you to know what the outcome of the procedure would be for me. But any comments or considerations. Or maybe links or other resources that might help me decide?

I mean... I don't think the surgeon would be telling me to take time to think about it if he didn't think there was much chance of it achieving the desired results, right? Or maybe I'm getting greedy and this is too good to be true?

Thank you in advance for your time and consideration.

This is the typical outlook my patients have expressed to me who have benefited from a skin reduction chest lift who understood the power of scars on the chest as exit points for excess skin and the compromise needed.

There was a guide by Dr. Bermant which detailed which angles to photograph. I followed his guide located on his website. I also tried to resize them so they would fit nicely on the forum. If any of the pictures are inadequate or too small, or if you otherwise feel more photographs necessary, I am always capable of resizing, taking, or retaking photographs.

Once again, thank you for your time.

Your images are very well done, but miss a critical point. Many years ago I embarked on a paradigm change: a more critical evaluation system for contour problems of the body and documentation of the surgical changes coupled with a system to enable patients to send me pictures for a telephone discussion and minimize travel to Virginia with surgery scheduled for the day after that visit. I had learned that the problem of male chest contouring, one problem nor one solution did not fit all. One subset that required a totally different approach, were the major weight loss patients with a loose skin component. That is why there is a separate section on my site for Male Mastopexy Chest Lift with its own set of Standard Pictures. You have used my Standard Gynecomastia Pictures set, which alone can show that your nipples are well beyond my Internal Lift. Many patients wanted the low nipples lifted but also wanted to avoid extended scars. I evolved my Internal Lift that can lift up low nipples but leaves the loose skin behind. However, this Standard Gynecomastia Picture set did not fully demonstrate the extent of the problem, nor just how effective the results were.

I use gravity to pull the skin away from the body. In addition, I am trying to establish just how low the lower edge of the areola is in relationship to the lower part of the pectoral muscle. So I added the arms on hip flexing muscle view to the oblique and side views. These additional views, as well as the even more critical videos really were able to permit me to better document the problem and how my surgical technique was fixing that set of circumstances. Early after surgery pictures and videos also permitted me to document just how well my patient's were doing for swelling and bruising after surgery. Yes, the images on my site are typical for my patients, both for outcome and evolution after surgery. Some really just do not get it. Those images are not for marketing, they are to help my patient be better informed and for me to better take care of them. If one of my patients does not look like that progression, I ask them to call me immediately so that I can better understand what is going on and intervene. The neat thing is that we then get very few such calls, because this is what they look like. The system in place has permitted us to accurately predict what type of surgery is needed before the hands on in office exam with extremely high accuracy helping our patients minimize travel to Virginia

Any way back on point, you ask questions about what compromise you should take. You will need to better understand just how such skin reduction options look like in the hands of the offering surgeon. The extent of scars, how the tissue moves, compromises made in each case are issues that are poorly described with words alone. They are best understood with pictures movies and links. Sorry, such documentation is no longer permitted by the new owner. Yet, if a patient needs to make an informed decision, they need such tools to understand such options. If interested, use my email link if looking for this type of resource.

Hope this helps,

Michael Bermant, M.D.

[Dr. Elliot Jacobs]

My breasts are the result of loose skin leftover from childhood obesity

That is the key to your problem.  Once skin has been stretched out by being obese, it is stretched out forever -- even if weight is subsequently lost.  Your situation is precisely that:  you do have a bit of "condensed" breast tissue (the volume of intervening fat has obviously diminished with the weight loss) which is contained in a loose "sock" of skin.  Yet, your skin still retains some elasticity (albeit reduced from what is normal).

When I have had cases similar to yours, there are two considerations.  First, remove all the excess tissue inside the skin, and second, how to deal with the excess skin.  My other over-riding goal is to provide the best possible result with the least amount of scars on the chest.

First, what to avoid:  I never, never, never do an anchor incision -- too many scars.

Second, how about a donut mastopexy?  Possible, but there are technical considerations that preclude a really tight chest with excellent contours and a thin, uniform pinch of skin and fat.  Plus the resultant scar is unpredictable and prone to distortion of the round areola, spreading of the scar, etc.

My preferred method might be considered a two-stage approach.  I first do my standard, minimal incision surgery and get a thin, uniform pinch of skin and fat over the entire chest.  Sometimes I can elevate the areola with some sutures inside.  With this method, the skin will undoubtedly tighten somewhat -- but just how much is unpredictable.

We then observe the results for about six months and at that time, both patient and I re-evaluate the results.  If the results are good (perhaps not perfect but acceptable to the patient), then nothing more (and no additional scars) need be done.  If there is still some objectionable skin laxity or the nipple is too low, then additional skin excision (and perhaps nipple elevation) can be done -- but since the skin has tightened somewhat during those six months of observation, the amount of extra skin is significantly less and therefore the needed skin excision is smaller, thereby yielding smaller scars.


This scenario should be discussed with your surgeon prior to your surgery.

Best of luck!!!!

Dr Jacobs

[qwop]

Currently I believe I'm leaning towards the donut incision with liposuction.

I've seen some of the complications from it, but most of them seem most noticeable only when bare chested. As I've mentioned, normal appearance when covered by clothing is my expectation, but acceptable bare chested is too good to ignore if it can be done. I just don't want to get greedy with the compromises and not accomplish either of these as a result. My main concern was that perhaps I had too much skin for this type of incision to do much. But thinking ove the discussion with my surgeon, and the input given here, I feel more confident that he may have been telling me to consider it more because he felt it was the better option.

Still gathering as much information as I can before I see my surgeon for one final discussion about the decision, thanks.