Gynecomastia surgery after weight loss

[oofid]

Hello everybody. I have read quite a few threads on here, but have not seen any where the patient has lost a lot of weight first that caused their gynecomastia. I have lost around 10 stone and have loose skin. It was worst around my waist, but also quite bad on my chest.

I had a consultation with Dr Levick about 2 months ago and he proposed a routine surgery where he removes the gland through the armpit, much like the majority of those carried out on this forum. My concern is that I have more loose skin than I do excess flesh, and that without skin removal I might look worse after the surgery. He thought that would not be the case as the skin would stretch back, but I believe that my skin has already stretched back as much as it ever will. Here are some photos. This forum won't let me link to another website directly, so please just remove the < and > at each end.

<imgur.com/a/PsjS2>

I had an abdominoplasty 7 weeks ago, after these photos were taken. My plan was to have that first and then have gynecomastia treatment a few months later, so that I would be recovering from them both at around the same time.

Ideally I think that I should have incisions made across the top of my chest, then have the skin pulled up tightly. My nipples should be over my pecks, not below them! In fact I would say that they are at least two inches too low, and if I had the normal surgery then they would stay where they are now.

Does anybody have experience of that kind of surgery? Or has anybody here seen Dr Levick after a lot of weight loss, and had the standard procedure without skin removal? He told me that he would consider it, but would normally only do it for people with much saggier skin than me. He advised against it because of the obvious scars it would leave from armpit to armpit.

Any answers would be much appreciated. Thanks!

[thetodd]

congrats on the weight loss!

How old are you? And who done your abdominoplasty what were their views about the loose skin around your stomach. Skin removal is a serious procedure, and it does leave visible scaring so anything that could be done to avoid it would be a bonus. I do agree with you, it does sound like wishful thinking but hes done a lot of overweight guys on here before, but you are the first guy that i can recall whos lost lots of weight and has loose skin.

Moving the nipples around is quite complicated aswell from what ive read, because if they dont get a constant blood supply they can die etc and that leaves scaring but if you were having skin removed i suppose they would be moved back into place when the excess skin was removed. I mean am i right in thinking that they actually just cut the skin away and pull it back like in a facelift?

It's clear that you have an ultimate goal here, i dont think this is going to be your standard fee so you may benefit from seeing a few surgeons maybe some who specialise in skin removal etc. The good thing about Levick is that you get free revision post op, but im not sure how far that will stretch when it comes down to skin removal.

Has anything been offered on the NHS at all regarding skin loss, i know its wishful thinking these days but maybe thats an option for the skin removal.

[oofid]

I'm 28. I was always overweight growing up, always about as many stone as I was years old. I got to 20.5 stone by the age of 23, then lost 10 stone over 3 years and have kept it off since then.

My abdominoplasty was done by Mrs Kat, who is also based in Birmingham. My stomach area was the worst, but I'm definitely quite sensitive about the chest as well. I have slightly loose skin everywhere, but I think that my torso had the worst psychological effect on me. I can live with it everywhere else.

Both Mrs Kat and another surgeon have suggested another idea that would remove skin from my chest without leaving a scar. They suggested cutting my nipple entirely out, then cutting out another larger circle, then sewing the nipple back into that larger hole. It would not remove very much skin, and would involve quite a bit of trauma to my nipples! It was my idea to slice across the top and pull everything up. To me that would preserve the important stuff. Plus the scar would run across the top of my peck, along the crease that starts at the armpit, and I don't think it would look terrible. If it did I would consider getting it covered up with a tattoo. My abdominoplasty was straight forward. I'm a bit anxious about this because my intuition of what I want goes against what every surgeon has recommended so far.

I'm really swaying between Dr Levick's standard surgery, and having the skin removal and a big scar. I suspect that I won't be happy with the loose skin (and low nipples) of his standard surgery, but I might be happy enough to live with it. Scarring across the top of the chest might prevent me from swimming and doing other topless activities, which would be a bit of a bummer.

The NHS have not offered anything. I went to my GP about 2.5 years ago and sought a referral. They said that I did not qualify although they never gave me any reasons. I think it was because they believed that it was not causing me depression or was debilitating. I run marathons and do a lot of other intense sports (that is how I lost the weight), so I can imagine that they saw me as low priority. I have been told that due to budget cuts, purely cosmetic surgeries like this are almost unheard of on the NHS now. They will still refer you to the relevant NHS Trust, but 99% of the time the answer will be no.

Dr Levick told me that he had done the surgery I requested on others, but they were major, major weight loss patients (e.g. 20 stone lost), where their nipples were down to their belly button and there was no other way. Mine is really just like little flaps of extra skin, enough to pull my nipples down. I feel a bit narcissistic being affected by it really.

[thetodd]

I'm 28. I was always overweight growing up, always about as many stone as I was years old. I got to 20.5 stone by the age of 23, then lost 10 stone over 3 years and have kept it off since then.

My abdominoplasty was done by Mrs Kat, who is also based in Birmingham. My stomach area was the worst, but I'm definitely quite sensitive about the chest as well. I have slightly loose skin everywhere, but I think that my torso had the worst psychological effect on me. I can live with it everywhere else.

Both Mrs Kat and another surgeon have suggested another idea that would remove skin from my chest without leaving a scar. They suggested cutting my nipple entirely out, then cutting out another larger circle, then sewing the nipple back into that larger hole. It would not remove very much skin, and would involve quite a bit of trauma to my nipples! It was my idea to slice across the top and pull everything up. To me that would preserve the important stuff. Plus the scar would run across the top of my peck, along the crease that starts at the armpit, and I don't think it would look terrible. If it did I would consider getting it covered up with a tattoo. My abdominoplasty was straight forward. I'm a bit anxious about this because my intuition of what I want goes against what every surgeon has recommended so far.

I'm really swaying between Dr Levick's standard surgery, and having the skin removal and a big scar. I suspect that I won't be happy with the loose skin (and low nipples) of his standard surgery, but I might be happy enough to live with it. Scarring across the top of the chest might prevent me from swimming and doing other topless activities, which would be a bit of a bummer.

The NHS have not offered anything. I went to my GP about 2.5 years ago and sought a referral. They said that I did not qualify although they never gave me any reasons. I think it was because they believed that it was not causing me depression or was debilitating. I run marathons and do a lot of other intense sports (that is how I lost the weight), so I can imagine that they saw me as low priority. I have been told that due to budget cuts, purely cosmetic surgeries like this are almost unheard of on the NHS now. They will still refer you to the relevant NHS Trust, but 99% of the time the answer will be no.

Dr Levick told me that he had done the surgery I requested on others, but they were major, major weight loss patients (e.g. 20 stone lost), where their nipples were down to their belly button and there was no other way. Mine is really just like little flaps of extra skin, enough to pull my nipples down. I feel a bit narcissistic being affected by it really.

At 28 your skin elasticity should still be pretty good, the weight gain/loss may have effected this but usually the skin would snap back after surgery but since you have a bit already on your chest i really dont think your going to be happy with the result of just lipo/excision

If they can do what you describe and you can cover it with a tattoo i think youl be happiest with that i think you will probably need skin removal. And your prob best sticking with your original surgeon. You could learn how to cover scars up with makeup aswell, there are decent tuts on youtube for that

Annoying about the NHS, but i expected it really annoying when you've put the hard work in!

Mate there is nothing narcissistic about it, everyones had the same thought but its your money and you need to do what makes you happy do it while your young you will heal quicker with better results. You need to go with what you thinks best, but i think your going to be underwhelmed by excision/lipo and out of pocket really.

[oofid]

I think that what I want ideally is a scar that goes from my armpit and into the groove where my collarbone sticks out, with the skin pulled up by about an inch, plus gland removal and liposuction around the nipple. But I have not seen this kind of surgery ever done. Even in extreme cases, for example female-to-male chest revision (e.g. <http://drmosser.com/transgender/ftm-chest/> ), they put the scar below the chest. But it seems to me that that damages the best part of the chest, the nipple. It wouldn't bother me much to have a scar across the top. I already have one all the way around my waist and having that definitely lowers your requirements for invisible scarring!

[kingboob]

Wow it has been a long time since I posted on this forum but for some reason today I had the urge to check in and see what is going on and I noticed your thread.

I'm also a massive weight loss guy, went from 34st to about 17  (I have since put a fair bit back on mind you...).   My loose skin was a lot worse than yours and on my chest I had full blown saggy breasts.  

I had exactly the surgery I think you are are describing - a long slice across the top of the chest, everything lifted up about 3 feet and stitched back together! Very much like the breast removal FTM pictures you linked to above but with the scar being full length and above the nipple line.

However, I recommend you think very carefully about having this type of surgery for several reasons:  

There is no way to predict how you will scar and you could end up with a very thick scar right along your chest.  Depending on how high up the cut is you may even be able to see the scar if you wear a polo shirt with the buttons undone.   If you have a really hairy chest the hair will not grow on the scar and it will look a bit weird having hair above and below and then a line of smooth skin.

While you do have loose skin and mild gynecomastia your situation really isn't too bad.  I suspect it could be corrected with less drastic measures.
  
Finally this type of surgery does place the nipples higher up, but they could get pulled too far to the sides.  Also because of the dramatic cutting and lifting involved you may experience permanently altered sensation in the nipples.


I've had multiple surgeries for the excess skin; chest, stomach, arms, thighs, etc,  so any questions fire away.  

HTH.





 

[oofid]

Awesome! Thanks for replying.

When you had your chest lifted, how tight was it afterwards? Did it restrict your movement a lot? If so, were you able to get it back with stretching and exercises? One surgeon told me that chest skin is usually the stretchiest in the body. If I reach above my head or behind my back the skin becomes reasonably tight, even though it is loose when I am relaxed. That suggests that if I had some removed I might not be able to stretch my arms out very easily. Did you find that?

Surgeons have recommended that I cut around the nipple and remove some skin that way, but I just don't think that it will be enough, especially as my skin will get looser after having liposuction. I actually think the whole area would look worse if I had standard gynecomastia surgery than it does now.

[kingboob]

My chest was very tight afterwards and yes it restricted movement for quite some time; I'm talking months to years not days or weeks. Even years down the line I can still feel slight tightness and restriction if I stretch my arms out to the very extreme. However day to day it isn't a big issue, you would only notice if you were trying to do some acrobatic yoga move or something.

Being a big long cut it takes longer to heal than the standard chest surgery, there will be variable swelling and tenderness for months, plus the scar can take years to mature and fade.

Also, how do you scar??   I found that it is true what they say about the skin on the chest, it is very stretchy -   Mine was super tight after my first surgery but over time the scar 'stretched' out again and became quite wide, so I had a second revision surgery to try and neaten it up.  It is better now but still stretched a little bit again over time.


I'm not trying to put you off, just give you a realistic idea.  Based on the images you linked to I'm really not sure you need such a drastic procedure.  To my eyes it looks like your skin could snap back if the fat was removed behind the nipple and I even wonder if doing some chest weights in the gym to build up your pec muscles could help.   Your nipples are slightly low but not freakishly so, the left hand one looks OK, but I do admit the right hand side looks a bit odd. 

Mr Levick did my surgeries and I'm sure if he felt you needed such an operation he would have recommended it.  I believe Mrs Kat is known to be a very good surgeon as well, I doubt she would shy away from a challenging surgery if it were required.

I had very large breasts, quite frankly I needed a bra. After the surgery I'm happy just to be able to wear clothing without having 'weirdness' going on underneath.  However I would never go swimming or go topless in public.   

Given that your case is nowhere near as severe I'm not sure it warrants such a big compromise?   Think carefully, don't rush into anything and go for second consultations if you think that would help you decide.  You have already had one massive surgery only 8 weeks ago and your body really needs a bit of time to heal before going under the knife again.

[oofid]

Thanks again for replying.

I'm not sure how badly I scar. I do have some scars that have lasted a long time. I don't think they really bother me though. The one all the way around my waist doesn't bother me. I have stretch marks all over my front and back which don't bother me. It is extra skin that bothers me.

The limited range of movement does concern me as I climb, swim, and do yoga, and they are all really stretchy. I do intend to start doing some weights in the gym to tone up a bit, but my main sport is long-distance running, and I have gone through with the surgery so far in order to get better at that (as well as look better). I would rather be slim than muscly.

I think I do agree (or am close to agreeing!) that this procedure might be too drastic for me, i.e. I would not gain as much as I lose from it. I'm quite hesitant because I only really have enough money to have one shot at this, so I can't afford a half-measure.

I think I will ask Dr Levick again and go with his recommendation. Thanks. If you have put some of your weight back on, did that contribute to your skin getting tighter? Or did your body find other places that hadn't been tightened to place the extra weight?

[kingboob]

Thanks again for replying.

I'm not sure how badly I scar. I do have some scars that have lasted a long time. I don't think they really bother me though. The one all the way around my waist doesn't bother me. I have stretch marks all over my front and back which don't bother me. It is extra skin that bothers me.

The limited range of movement does concern me as I climb, swim, and do yoga, and they are all really stretchy. I do intend to start doing some weights in the gym to tone up a bit, but my main sport is long-distance running, and I have gone through with the surgery so far in order to get better at that (as well as look better). I would rather be slim than muscly.

I think I do agree (or am close to agreeing!) that this procedure might be too drastic for me, i.e. I would not gain as much as I lose from it. I'm quite hesitant because I only really have enough money to have one shot at this, so I can't afford a half-measure.

I think I will ask Dr Levick again and go with his recommendation. Thanks. If you have put some of your weight back on, did that contribute to your skin getting tighter? Or did your body find other places that hadn't been tightened to place the extra weight?

Scars on the waist are a bit easier to hide with clothes though, even on the beach the tummy tuck scar would most likely be hidden by shorts.  I don't think weight gain made my chest tighter....I did gain a couple of stone back most of it seemed to have gone on my stomach and legs, and if anything they are looser than before.

As I said building up the pec muscles might help but if you are a runner then bulking isn't really an option for you.

I don't know how it works these days but when I had my surgery most surgeons who were popular on this forum were offering free revision if the surgery wasn't satisfactory.  I would ask the surgeon what happens if you go with the non-skin or minimal skin removal options and the result is poor, will they revise for free.  Also ask them what the intended outcome is - having a flat chest is a bit different from having a flat chest you are happy to show off.

How would you feel about explaining the long scar across your chest if you do go shirtless?   It is quite a tricky location to explain away really; the scar for heart or chest surgery is normally vertical.