Periareolar mastopexy and Lipo

[Dghtx832]

How's it going doctors? I had an evaluation with a certified top plastic surgeon here in Houston Tx. He recommended i get a periareolar mastopexy since i had minor chest sagging with liposuction and well removal of gland. I am now a little from 4 weeks post op and im seeing an unsatisfying amount of scarring forming around the areola. I am also noticing my areolas kind of spreading out a bit ( getting bigger). Is this normal? I am only 21 years old and i dont know if im going to be pleased with my final results. I'm very nervous. I paid $6000 for this procedure. I must admit i did have minor chest sagging of my areola so he only repositioned it a little under 2 centimeters upwards. I did feel chest tightening as in around the areola as if he removed a good deal of skin for the first week. Now my chest feels about normal but does not completely look it yet. My 2 main concerns are horrible scarring around my areola and my areolas getting to the size of pepperonis. 😞. Any advice please?

[Dr. Elliot Jacobs]

Sorry to hear about your problems -- but they were predictable.

First, as a 21 year old, your skin has a lot of innate elasticity.  Had the surgeon removed the gyne, the skin more than likely would have self-tightened and you may not have needed the peri-areolar mastopexy.  Unfortunately, once the mastopexy has been done, the scars are there forever.  And yes, they do tend to spread and yes the areola tends to spread out as well.  

Perhaps the best thing to do now is simply wait and allow the healing processes to proceed and anticipate that the scars will eventually fade.

Your case illustrates while I am adamantly against peri-areolar mastopexy or inverted-T breast reductions on a male -- there are simply too many scars.  My best approach is to perform minimal scar surgery if at all feasible, then observe for six months or more for skin tightening, and then address any residual lax skin in any one of several minimal scar methods.

Dr Jacobs

[Dghtx832]

Dr. Jacobs, so are all male periareolar mastopexys a disaster or do some cases yield some success? I was online reading that if you have minor to minimum chest drooping like i did, a periareolar mastopexy should be be an ok procedure to be performed. Should i give it some time? Im barely 4 weeks post op. Is there a procedure for reducing areola size and if there is will my surgeon perfom it for free?

[Dr. Elliot Jacobs]

No, I cannot say that all peri-areolar mastopexies are a disaster.  More than likely, in some circumstances, this procedure might be the right one.  It's just that in my experience of many thousands of patients, I have yet to come across one instance when I would believe it would be the correct procedure for the patient.  There are many ways doctors can approach gynecomastia -- this is just my opinion.  Some of my colleagues may disagree.  That's fine, as long as the results justify the operation.

Yes, there may be a procedure to reduce areolar size -- but that would require a minimum of six months of healing.  The procedure would, in essence, be a re-do of the mastopexy but only aimed at reducing the width of the areola.  And, in order to take tension off the skin closure, a permanent or semi-permanent suture would be required around the edge of the areola to try to prevent spreading of the scar and spreading of the areola again.  And this suture would be feel-able under the skin. Yes, there is hope.  Whether you surgeon will accommodate your request will be up to you and him.

Dr Jacobs

[Dghtx832]

Thank you Dr. Jacobs
Your response puts some ease to my mind. I hope my outcome becomes good in the months to come. I am very young at 21 and been dealing with gyno since 13, its been a horrendous teenage life, and i couldn't be able to possibly picture moving from actual man boobs to actual female looking areolas. The scarring im concerned about but the areolas spreading is what is scaring me the most. I hope like you said this mastopexy was the correct procedure needed for my chest. My plastic surgeon seems knowledgeable. He promised me that in the 14 years of plastic surgery he has been in , not one of his patients was disatissfied with their results. He seems more knowleadgeable with female breasts though i must admit but he says he has seen plenty of male parients dealing with my issue as well

[Dr. Elliot Jacobs]

Good luck and keep us informed as to your progress.

Dr Jacobs

[Dghtx832]

Thank you doctor
I will post pictures here when my scabs have healed so you guys can take a look at them or i will start a new thread.

[Dr. Schuster]

Just for another and different opinion. I do believe that peri-areolar skin removal is indicated in selected patients and that there is no reason to do this in two stages. There are many patientss that I have treated that simply do not have adequate skin elasticity. Without the removal the areola is more likely to develop irregularities of creases or depressions. in addition, in these patients it is more likely that residual folds will remain, especially inferiorly towards the crease. I believe that the procedure can be done and leave a very acceptable scar. Again it should be done in selected patients. 
I write this only to present a different point of view. This is where the "art' of medicine has meaning. Different experienced surgeons can get great results with differnet procedures. Similarly, inexperienced surgeons can get bad results with different procedures as well. i completely agree with Dr. Jacobs regarding the inverted T incision, which I do not believe is ever needed in primary correction.