to the doctors

[bluemrgreen]

I know you guys wait until later before removing extra skin to avoid scars but lets say its evident that after the surgery and nipple shrinkage there would be sagging skin. If the patient wanted and didn't mind lets say some additional scarring,would you take the extra skin off if it was possible or would you still have the patient wait for a second smaller procedure in the future?

[George Pope, M.D.]

In the typical case of gynecomastia surgery, where breast tissue is excised through an incision on the underside of the areola, removal of excess skin has to be delayed.  If there's a lot of excess skin, it needs to be removed from all around the areola, and doing that at the time of the initial surgery would interrupt blood flow to the nipple/areola.  For this reason, the skin removal procedure most be postponed.  Another method, which has been described on this forum numerous times, involves removing the excess breast tissue, fat, and skin all at once, with grafting of the nipple/areola as a skin graft.  That's a more aggressive procedure, leaving more scarring on the chest.

Dr. Pope, MD

[Litlriki]

In patients with large areolae and limited but obvious skin excess, I will perform simultaneous peri-areolar reduction along with resection of the underlying breast tissue.  In these cases, the nipple remains attached to the underlying tissue, rather than treating it as a skin graft.  There are several examples of this procedure on my website under the group of patients requiring skin resection.  There is obviously more scarring in this surgery, but more importantly, there is increased risk to the nipple viability, and it must be done very carefully to avoid compromise to the nipple.  Many surgeons will not do the procedure this way, but rather opt to do the subcutaneous mastectomy with a delayed skin reduction six months to a year later.  I do this as well if the need for skin removal is borderline.

Rick Silverman