Weightloss before consultation

[ItsGoneIn2019]

So this topic by Mike80 got me thinking 

https://www.gynecomastia.org/smf/ask-a-doctor/38/weightloss-before-surgery-dutch-healthcare-rules/35304

What DO I  do about weight before surgery? I am taller than I  am wide and just above the 30 BMI mark (6'4 and 255 lbs at the moment). I actually started to exercise earlier this year and burned off some fat, but stopped because of how my stomach was shrinking disproportionately to my chest, which stayed the same. I  lost 28 lbs last year (that I did gain back unfortunately) and noticed the same thing: I had to buy a new belt because my work pants were falling off my butt at work, but I still struggled to put on some of my shirts without unbuttoning them.

I am actually very frustrated by this. On one hand, my goal is to burn fat, but on the other, I don't want my gynecomastia sticking out like a sore thumb stung by bees.

Also, I am going in for a consultation in about a month. The secretary said I'd have to be at a stable weight to do the surgery.  This also frustrates me: my goal is to burn fat, not lose weight.  Personally, I dont want to drop below 230lbs if I  can help it. What should/can I do?

[Dr. Elliot Jacobs]

There is no right answer to your question.  Obviously, being at your lowest and most stable and most acceptable weight is desirable.  But people are people and many guys have reasons they can't or won't lose weight.  then it is up to the patient and the surgeon, after a physical exam, to discuss the pros and cons of surgery at your present weight or at a lower weight.  Ultimately, you can reach a reasonable solution and you must be realistic as to your goals.

I do this all the time with my patients -- not all are perfect candidates for surgery -- but if they are realistic and accepting of my caveats, then we can proceed.

Dr Jacobs

[Dr. Schuster]

It is usually the case that as guys lose weight and become more lean, their gynecomastia looks worse. I generally recommend that guys lose weight before surgery in order to get down to a healthyweight that they can maintain. Sometimes it makes a difference regarding skin elasticity. There's not any real strict rule though.

[Litlriki]

Being close to or at a goal weight may be ideal, but it's not always a possibility. Discussion of this is critical to address expectations for patients, but often, multiple factors need to be considered, and timing of the procedure related to weight and body habitus may be a compromise in the end. The end result in someone who remains heavier than ideal may leave the patient with a chest that looks like it belongs to a thinner individual, or it may leave some fat behind so that the chest looks more consistent with the rest of the body. In the former case, the patient can then proceed with his dieting to get his tummy to match his chest. In the latter situation, the patient might require secondary liposuction of the chest after losing additional body weight. Discussing this before surgery is essential to make a plan. 

[ItsGoneIn2019]

I discussed with my surgeon.  He said he can make my chest flat, but then my gut would be more visible. Sad that I have to admit to having a gut, but no problem: I  can easily deal with it. I've done it before and have already started taking the steps to do so again. I'd just rather not have my chest fat being as prominent as it was last year.

Again, thank you all for the feedback.  I really appreciate it. 

[Dr. Elliot Jacobs]

It's funny but I also mention to my pre-op patients who are overweight that I can get their chest flat -- but then their abdomen may appear to be disproportionately more noticeable.  And every guy has said the same thing -- he can live with that or take care of that via diet and exercise.

Once in a while, a post op patient will return and say that despite everything they did, their abdomen did not change that much.  Then we sit and talk about liposuction of the abdomen and love handles.  

Unfortunately, when men put on weight, it goes to their chest, abdomen and love handles.  And when one diets, one cannot dictate to one's body where you want the fat to disappear.  Oftentimes, those same areas stubbornly hold onto their fat and it is difficult to achieve fat reduction via diet and exercise alone.  Some doctors have observed that men who have died of starvation still had some stubborn belly or love handle fat.

Dr Jacobs 

[Litlriki]

Echoing the comments regarding the belly after treatment of gynecomastia, I've also had patients come back later to address the abdomen and flanks, but sometimes the body fat inside the belly still causes a round stomach profile rather than a nice flat belly. Patients need to be cautioned with regard to anticipated outcomes if they don't have so much superficial fat since liposuction will only address what's on the outside.