ADVICE NEEDED - Weight Loss/Gynecosmastia/ Chest Option

[Tlamont]

Hello All,
I have been reading many posts and questions and I just wanted to post mine.
I am 31 years old, 6'1 280lbs. My highest weight was about 360lbs. I want to get down to about 255lbs then to about 230lbs. I am looking better and better everyday and due to diet and resistance training my body is transforming. But of course I have a saggy chest (pictures attached) and the back/side fat.
I visited a local plastic surgeon who made a recommendation for a mastectomy/excision, lipo and nipple graft.
He had my support until the nipple graft, which I have read and researched to be an easy procedure but I wanted some opinions on other options that could possible be done. I am not looking for a flat chest but a well proportioned for my body and the changes taking place.
The muscle is growing underneath and I can envision how I would look after surgery.
The fact he stated I would shave off your nipples, put them on the back table and stitch them back definitely turned me off from the procedure. I have had them so long, and I have become comfortable posting shirtless pics online, wearing tanktops. although the surgery would help to give a better look..

Is there any option to lift of chest, not concerned with scarring as I plan to get tattoos when the time is right. I have also include a before weightloss picture.

BEFORE LOSS


CURRENT

[Dr. Schuster]

Congrats on your transformation. You look great. I definitely agree that you would get the best results with a mastectomy ype of resection with nipple graft. Your breast skin is not going to shrink with any other type of surgery. I would also recommend that the additional fold along the lateral side of your chest be removed. It will cost you a little more and the scar will be longer but it will be well worth it. I would not recommend anything that would include a vertical scar. Those do not heal well. The horizontal scar generally heals ver well and at the very least you will be able to wear tee shirts and feel at ease. Good luck.

[Dr. Elliot Jacobs]

I totally agree with Dr Schuster -- a mastectomy with nipple graft reconstruction would be the only way that I know to get a nicely contoured, masculine chest.  And it would be worthwhile to extend the operation along the side of your chest in order to tighten the skin there as well.

This is all done with the anticipation that there will be permanent scars -- that is the trade-off for a trimmer, tighter and more comfortable chest.

Your first surgeon was correct -- unfortunately his honesty put you off.  But you now have two corroborating opinions.

Good luck!

Dr Jacobs

[DrPensler]

Great work on the weight loss. I am not a fan of nipple grafts in cases like yours. I prefer an omega type of incision with significant skin resection. For my patients I have found the results superior to any nipple grafts.

[Litlriki]

I would join the other surgeons in congratulating you on your weight loss.  As you continue to drop weight and build your underlying muscles, you're doing a lot to help you get a better result in the end. I agree that skin excision will be required to address your chest, and at this point, it may be the case that a free nipple graft is your only option to address the nipple/areola.  I've only used a free graft on rare occasions, and instead, if the anatomy allows it, I prefer to keep the nipple on a small flap, which gets tucked under the larger superiorly based skin flap and allows for the nipple to be repositioned without detaching it from its blood supply.  Your surgeon will certainly address these options when the time comes, but I'd encourage your ongoing efforts with further weight loss and muscle building to get you to your best result. Good luck!

[Tlamont]

Thank you Doctors! I have been praying and thinking and I believe this is the best option to have surgery because as I keep losing weight I know the chest will never form how it should! I plan to have it I. December when I can take a few sick days and winter break from school (educator) to start recovery

Thank you!!

[Dr. Schuster]

Good luck. Keep this site posted on your journey. I'm sure that many others just like you will find some inspiration.

[Michael Law, M.D.]

Congratulations on your weight loss. You look great and gynecomastia will make you look even better. 
Although I do everything possible to avoid scarring, your situation is one that requires mastectomy style incisions for the best contour. It also sounds like you have a plan for covering the scars with tattoos. All gynecomastia surgery requires expertise. You situation truly requires an expert plastic surgeon. I encourage you to find some plastic surgeons on this site. Plastic surgeons are on this site because we have a true passion about gynecomastia and surgeons with expertise can be found here.
Please keep us posted on your transformation. We are all rooting for you.