A question regarding surgery

[MrOnedaygynefree]

Hi doctors and thank you for your time. I have moderate gynecomastia but I noticed that right under my armpits and extending my back I have like a layer of fat. Do you guys liposuction that as well if the patient asks for that . I also noticed that part of my body under my armpits extending through my back where the fat is my skin is also loose and has stretch marks. As im loosing weight " I weight 220 " I'm 5'10 I lost 25 pounds and I'm going too loose 40 more before surgery  but so yes that skin is loose and im pretty sure it will get flabbier once I get too my ideal weight, can you guys get rid of that skin as well if the patient is willing to pay for it? Thanks for ur time!

[Dr. Elliot Jacobs]

Part of my routine exam is to examine the entire chest, not just the breasts.  I often recommend extended liposuction around the side of the chest towards the back, and even into the armpits if there is excess fat there as well.   The idea is to sculpt the entire chest because that is what people look at -- not just the breasts.  It would look silly and incomplete if one ended up after surgery with a flat chest but with residual fat sticking out on the sides of the chest.

In patients in whom there has been significant weight loss, sometimes lipo alone on the side of the chest is sufficient -- and sometime an excision of loose, overhanging skin is required.  In those latter cases, usually the breasts will be drooping as well and a different type of surgery is required.

For you, best idea is to lose all the weight that you desire and remain stable at that weight for at least a few months.  then consult an experienced gyne surgeon.

Good luck with your weight loss!

Dr Jacobs

[Litlriki]

Extra fat along the sides and extending into the armpit is very common with gynecomastia, and the liposuction contouring that is done in all procedures includes those areas.  When liposuction is performed, the skin retraction that follows can often minimize the need for extensive incisions in non-anatomic regions, but this is dependent on how much skin laxity is present, age, skin type, and the weight gain-weight loss history.  While the stretch marks won't disappear, the skin may tighten adequately to avoid incisions along the sides.  The process requires time after the suction procedure--up to a year--before going forward with skin excision.  Alternatively, in some patients, it's obvious from the outset that skin excision is necessary, and a different approach is taken in those cases, as mentioned by Dr. Jacobs. 

Rick Silverman

[MrOnedaygynefree]

Wow thanks that's real interesting and completely answered my question.  I cant wait! It must be exciting to be gyno free in the meantime  I'll loose this weight

[DrPensler]

Invariably  a component of the problem is glandular tissue and a component of the problem is adipose (fat) tissue. Both need to be addressed to optimize the final result.Skin laxity and muscle mass also influence the final result. With large skin excess and poor skin elasticity results are never optimal and may require a skin excision which results in additional scarring. Removal of the axillary fat ( arm pit fat) is typically required and is considered a component of the procedure.