Need some advice about skin tightening

[medicaltourist1]

I met with 3 fairly prolific gynecomastia surgeons in India. I’m from the US.

Age 35, 250lbs, 6’4”

Grade 2b/3 (according to the surgeons)


Surgeon 1 - Regular liposuction, 90% gland removal. No skin tightening. He wants me to wait 8 months to 1 year and then pursue skin removal/tightening if necessary. He is confident in a 90% chance that it won’t be necessary.

Surgeon 2 - Vaser liposuction, 90% gland removal. No skin tightening. He wants me to wait 8 months to 1 year and then pursue skin removal/tightening if necessary. He is confident in a 90% chance that it won’t be necessary. Says that the Vaser liposuction will cause skin to tighten after several months.

Surgeon 3 - Regular liposuction, 90% gland removal. Will only operate with mandatory donut mastopexy during surgery. However, this doctor has a track record of recommending this to almost all of his patients, to the extent that it seems to be pushing patients away based on reviews and experiences I’ve read.

Some of you on this board have expressed disdain with mastopexy and the possibly unnecessary scars. Personally, I would rather take the chance and have the revision down the road if required than to have the mastopexy scars.

Also, I’ve read This study and it seems to support not using mastopexy initially. I’m not a surgeon but I value your opinion on this. I’ve attached pics for your reference.

I won’t be having surgery in India as the level of hygiene here is dangerously low. 

[DrPensler]

I would not recommend option 3. There is a great maxim "Never do today what you can as well do tomorrow"( because something may occur which causes you to regret your premature action). While this is not true across the board it is applicable in your case.

[Dr. Elliot Jacobs]

Most guys with gynecomastia seek a contoured chest with the most minimum of scars.  Most guys are not aware that given relatively youthful and elastic skin, most gyne operations can be done with minimal scars and the skin will self-tighten during the procedure.

If you were my patient, I would do aggressive liposuction with gland excision and allow the skin to tighten by itself.  I think you would be surprised at the results -- without the need for donut or mastopexy scars.

If, six months down the road, you would want to do something to tighten any remaining loose skin, there would be much less (if any) skin to tighten and thus any scars from the skin tightening procedure would be significantly smaller.

Smart way to go?  Do minimal scar surgery first and then be patient.

Dr Jacobs

[medicaltourist1]

Thank you both so much for the replies. I have no problem waiting for results - it will just be a welcome relief to be rid of the gynecomastia and finally have my life back.

[Michael Law, M.D.]

Most men would, of course prefer one surgery to eliminate gynecomastia. In some cases, a staged approach can help the skin to contract so that a secondary surgery can be performed at a later time with limited incisions and ideally limited scarring. Of course this is something that would be discussed prior to surgery in order to determine what is most appealing to the patient.
I'm glad to hear you will be having surgery in the US. Gynecomastia.org has many very well trained plastic surgeons with a particular interest in gynecomastia surgery, This is a great place for you to come for answers and to start the search for a plastic surgeon.

Dr. Law
http://www.michaellawmd.com
The Plastic Surgery Center
10941 Raven Ridge Rd Suite 103
Raleigh NC 27614
919 256-0900

[Litlriki]

I also take the "less is more" approach in cases like yours, where the likelihood is that your skin will retract adequately without skin excision and resultant scars.  As you've observed, the more aggressive surgeon likely loses patients due to the potential extra scarring, especially when it's probably unnecessary. I think you're also wise to have your surgery in the US.  A number of years ago, I had an Indian patient who was working in Tokyo come to Boston for his surgery, rather than going back to India for it. I think that says something, though, of course, there are many Indian surgeons who are skilled and capable of performing this surgery with good results.  It's wise to do your research. Good luck. 

[Dr. Schuster]

I think I agree with the other docs unless on exam your skin turned out to be very loose, in which case we wold discuss a peri areolar skin reduction. if done well the thin scar around the areola is well worth it. You're going to get about half of it anyway by docs who do the standard lower peri areolar approach. I have no problem with doing it initially or as a delayed procedure and I always have that discussion with my patients. At least half want the max done at the first setting.