Really need advice

[percy46]

Hello Doctors.
I've suffered with Gyne since puberty (I used to be reasonably overweight). Now in my mid 20's and have lost about 80lbs. I know its difficult to assess from photos, but do you feel I would require open surgery, or do you feel my skin would be elastic enough to have a nipple incision/lipo (As I've already lost a lot of weight)
I'd like to add that the photos make my breasts look smaller (or maybe thats my mind playing tricks) and that it was very cold so my nipples look smaller than usual.
I'd appreciate any advice
Thank you.

[Dr. Schuster]

From the photos it looks like you have significant skin laxity. I do not think it will shrink down after standard removal of the breast gland. I think you would probably be fine with just a peri areolar skin reduction. This would leave you with a scar that goes completely around the areola. it generally heals very well. Obviously without an exam this advise is limited. Good luck.

[percy46]

Thank you for the reply. Thats put my mind at ease somewhat. I've been to see 2 surgeons. The first said I'd be best having open surgery, which shocked me but once I had time to think about it I was fine with it. My skin is loose as I've lost so much weight. It's especially noticeable if i were in a plank position (even around my stomach aswell)
The second surgeon said I'd have a small incision, and lipo, and I'd be in and out in 40 mins and it really made me feel uneasy about the whole process. 
Because of the skin laxity, I'm happy to have open surgery, personally, scarring doesn't bother me. The only thing that would bother me is if I have the scars, and find that they were completely unnecessary. But that doesn't seem to be the case, so I think I'll see my surgeon for a 3rd time and book my surgery. When I do so i'll make a thread and share my experience.
I look forward to hearing what other surgeons have to say

[Dr. Elliot Jacobs]

Yes, you have gyne and have some lax skin from having been overweight.  It is difficult to assess the elasticity of your skin from a photo -- a hands-on exam is really needed.

In patients similar to you, I like to discuss a 1-2 type of procedure.  A first very aggressive procedure to remove the excess tissues (you would need a 1/2 circle peri-areolar incision) which includes large skin undermining plus liposuction to even things out.  And then we wait....and observe... and give your skin every opportunity to self-tighten.  And sometimes over six months or more, there is significant tightening so that the patient is entirely satisfied with the results.

On the other hand, at six months, we often have another meeting and if there is still some skin laxity which is of concern to the patient, then we talk about a second, much smaller procedure just to tuck any residual lax skin.  But during that six months, the skin will have tightened to some extent -- so that any residual lax skin will be smaller in amount and hence would require a smaller tuck with smaller scars.

Lots of choices -- make sure you speak about all possibilities with your surgeon.

Good luck!

Dr Jacobs