Best surgery procedure for this gynecomastia

[gyne28]

Hi Doctor,
I am 28 years old from Mumbai, India. I have gynecomastia since i was 12. Recently on 8th Nov 2011 i had visited a plastic surgeon who is known gynecomatia doctor. After checkup he told me that he perform excision, liposuction & skin tightening on me. He told that my gland size is big enough & my weight is not constant so skin tightening is must. But i am pretty doubtfull on skin tightening as this required on very severe cases & i think mine is not so severe.Might be he may be correct in order to avoid carter deformation or any skin loosening effect in future.
My details:
Weight: 68 kg (+/- 3-4 kg quick weight fluctuations)
Height: 5.8 ft
Skin type: Loose & soft than normal man skin

I have pasted my recent pics.Please have a look & let me know the best surgery procedure to be performed on me.

[Dr. Elliot Jacobs]

You are young, mildly overweight and indeed have gyne.  In cases similar to you, I have performed lipo and then, only if there was residual tissue, would perform a gland excision.  I would not perform skin excision initially -- it will leave permanent scars forever.

Best is to have the minimal scar surgery, wait 6-8 months to allow your skin to tighten by itself, and then decide if skin excision is necessary.  My guess is that it won't be needed.

Dr Jacobs

[Litlriki]

I would take the same approach described by Dr. Jacobs, with initial liposuction and excision of glandular tissue through a short peri-areolar scar, followed by a waiting period to see how much skin retraction follows.  I would anticipate that the skin will retract adequately to avoid more extensive scarring, but if it didn't, I'd hope to be able to do any skin tightening with a peri-areolar incision, leaving a scar only around the areola.  I usually allow 9 months to a year before proceeding further.

Rick Silverman

[gyne28]

Thnaks a lot Dr Elliot Jacobs & Dr. Rick Silverman for your valuable comments.

[Dr. Cruise]

Hello,
I would agree with the skin excision for several reasons. 1) Your nipple is actually 1.5 to 2 cm lower than it appears. This will become evident when the volume is remove. 2) The distance from the bottom of your areola to the fold on stretch appears 2-3 cm too long. 4) Because of your heavy chest structure, your Infra Mammary fold has dropped about 1 cm. 4) Combining 1,2, and 3 means you have a significant amount of excise skin. 4) The excess skin of the breast roll will respond only moderately to liposuction.

All in all, without skin excision you will get a flatter result but it will look deflated and saggy. With time ie 10-20 years it will look even worse. My advice is to bite the bullet now, remove the volume, and tighten the chest skin envelop. If done will little tension, the scars will heal nicely. Complete maturation of the scar takes 2 years especially in darker skin. The upside, in your case, is that you actually have some hair right where the incisions will be. They will help cover the incisions. One final note, be sue to have the excision go back as far as your loose skin. If you do not there will be a dog ear.

This has been my experience, however, removing only volume and seeing what type of skin contraction you achieve is also a reasonable option.

[Dr Kapoor]

This is a fairly tough case but i think you have the potential for a great result. My recommendation would be to do the liposuction in addition to gland removal at the first stage and wait 4-6 months to see how well the skin envelope tightens up. I think because you are young and appear to have fairly good skin quality, you might be able to avoid a skin tightening procedure but only time will tell. Good luck!