mix of gyno and chest ptosis? surgery only hope?

[mooninite]

i weighed around 190-200 when i was 13-14, now i'm 150 lbs, about 6ft and 22 years old.  i originally thought it was just gyno, but i think there's still some fatty tissue there and a bit of sagging skin (one pic shows some around my gut too).  unless i put on a bunch of muscle, i'm guessing the only way to fix this would be through surgery for gyno and chest ptosis....just wanna see what people who can relate or at least educated on the issue have to say.  it sags and points out and screws my confidence.  it just sucks that i lost the weight and got into shape n i'm still screwed over.  thx for the input

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i could view the pics on my computer, but they didn't pop up on my phone n i'm guessing everyone else couldn't view them either.  hopefully the links will work and you can view them.  could someone comment on whether or not they can view them?

[Dr. Elliot Jacobs]

Why not post a series of good photos so that we on the forum can comment?

Dr Jacobs

[pharmerjoe]

you're not exactly fat or anything, so I would say it is mostly gland tissue that needs to be removed. Not sure why you say there is chest ptosis though? I thought chest ptosis would be when your man boobs just sag right down but I may be completely wrong.

[Dr. Elliot Jacobs]

I have had a number of patients similar to you.

You were heavy at an early age -- then lost the weight.  You now have residual tissue on your chest which is mostly gland, since the fat has mostly been lost through your weight loss.  However, you are lucky in that your skin seems to have retained a fair amount of elasticity. 

In patients such as you, I have done my standard minimal scar lipo/excision surgery and have seen significant contraction of the skin so that no additional skin excision or nipple elevation would be required -- good news!!!

Your abdomen, however, exhibits lax skin which probably would not tighten in the same manner as your chest. 

Dr Jacobs

[DrBermant]

i weighed around 190-200 when i was 13-14, now i'm 150 lbs, about 6ft and 22 years old.  i originally thought it was just gyno, but i think there's still some fatty tissue there and a bit of sagging skin (one pic shows some around my gut too).  unless i put on a bunch of muscle, i'm guessing the only way to fix this would be through surgery for gyno and chest ptosis....just wanna see what people who can relate or at least educated on the issue have to say.  it sags and points out and screws my confidence.  it just sucks that i lost the weight and got into shape n i'm still screwed over.  thx for the input

i could view the pics on my computer, but they didn't pop up on my phone n i'm guessing everyone else couldn't view them either.  hopefully the links will work and you can view them.  could someone comment on whether or not they can view them?

Weight loss has its limitations. After major weight loss, loose skin, residual fat, and gland can all be factors deforming a cut look of the male chest. I have seen so many patients over the years of my practice who have come to me frustrated after losing the weight only to have residual contour issues that act as cruel reminders of their deformity.

Your bending over view is the most critical of what you have posted. You have used a partial collection of my Standard Male Mastopexy Gynecomastia pictures I evolved to demonstrate loose skin and the male chest. Low nipples do not look good on the male chest. In particular the lower edge of the areola should lie higher than the lower edge of the pectoral muscle. That is why that set has an extended flexing muscles view (to demonstrate the nipple relationship with the muscle and the bending over views use gravity to show just how much loose skin is there. The standard set evolved to analyze the problem patients were coming into my office with as well as document just how successful the surgical sculpture.

My patients with major loose skin are carefully educated about the compromises needed when considering this component. Leaving the low nipples, skin reduction surgery which has scar compromises, my Internal Mastopexy Lift (raises low nipples but leaves loose skin an issue), and body shaping clothing. I have taken the time to document with examples each of those options on my site.

By targeting gland first I have been able to document an amazing shrinkage of skin with surgery. It is this same system of careful standard images that has permitted me to evolve my surgical techniques to achieve what I demonstrate on my website. Areola shrinkage has been a topic here before:

https://www.gynecomastia.org/smf/index.php?topic=19991.msg152393;topicseen#msg152393

The amazing demonstration seen on that page does not happen with skin stretched by weight loss. There is some shrinkage, but nowhere as great. Now we come to the crux of the matter, actual documented results vs. words. Look for actual examples, before and after pictures, that demonstrate claims of success. You will not see such pictures on my website for major skin shrinkage just by targeting gland first on the after major weight loss, because it does not work well. Yes, someone can say the method works but not demonstrate it with actual examples. Look for documentation like the standard loose skin pictures mentioned and even better videos demonstrating that the method works.

I have seen many patients come to my office complaining they had surgery done by another surgeon but did not get the results that surgeon said they would be getting. When I ask did they see pictures before surgery, a common answer was no. They were shown something else, not their problem specifically. The best way to avoid that situation is to actually look for such careful documentation of the method of that surgeon's techniques for that specific problem.

Hope this helps,

Michael Bermant, M.D.

[pharmerjoe]

damn, I think I have the exact same problem as you. So in this case, removal of the gland tissue could see the skin on the chest contract, but the skin on the abdomen would not contract if liposuction was done?

[Dr. Elliot Jacobs]

The chest skin has an amazing ability to tighten and contract -- that is why I rarely have to remove excess skin -- except in those patients who have lost significant amounts of weight or who are much older.  In fact, the younger the patient, the more elastic the skin.  That is why I believe no additional skin removal would be necessary.

The abdomen is another situation.  Once one has been overweight, the skin's elasticity has been reduced.  Lipo of the abdomen, though very popular, would not work well with lax skin -- it simply does not contract as well as the chest.  Many times a skin tightening procedure is performed at the same time.

Would not be able to predict in any individual case unless I actually had hands-on examination.  Therefore, if one is considering lipo of the abdomen, it is best to have a plastic surgeon assess the elasticity of the skin.

Dr Jacobs

[mooninite]

thanks for the responses.  i'll do some working out to tighten up some loose skin and diet to get into six pack shape (or as close as i can cuz my bit of extra skin on my stomach), so my body can target whatever stubborn fat i have in my chest.  if none of that helps enough to satisfy me, then i'll probably get the surgery next year (the sooner the better).  i just don't want my boobie sticking out so much from the nipple to the lower chest, i've got some pecs so a little isn't too bad.  i know i don't have a severe case, but **** me for being fat which may have messed with my hormones and did give me some loose skin.  the abdomen region doesn't bother me, it's just my chest; i don't wanna be able to prance around w/o a shirt on, i just wanna feel good with a shirt on.

as far as surgery goes, so if it's just the gland removed my nipple will sit unusually low and if it's raised i'll have that fold of skin by the nipples that you can see in some before/after pics. i'll have some time to think about it while i make some extra money for the surgery.  also, i'll try to remember to post some pics, if i keep my word about dieting and working out hard (so far it's going well), to show off what can be done to improve similar cases as me.

[DrBermant]

thanks for the responses.  i'll do some working out to tighten up some loose skin and diet to get into six pack shape (or as close as i can cuz my bit of extra skin on my stomach), so my body can target whatever stubborn fat i have in my chest.  if none of that helps enough to satisfy me, then i'll probably get the surgery next year (the sooner the better).  i just don't want my boobie sticking out so much from the nipple to the lower chest, i've got some pecs so a little isn't too bad.  i know i don't have a severe case, but **** me for being fat which may have messed with my hormones and did give me some loose skin.  the abdomen region doesn't bother me, it's just my chest; i don't wanna be able to prance around w/o a shirt on, i just wanna feel good with a shirt on.

as far as surgery goes, so if it's just the gland removed my nipple will sit unusually low and if it's raised i'll have that fold of skin by the nipples that you can see in some before/after pics. i'll have some time to think about it while i make some extra money for the surgery.  also, i'll try to remember to post some pics, if i keep my word about dieting and working out hard (so far it's going well), to show off what can be done to improve similar cases as me.

It can take 6 to 18 months for skin to finish tightening in some cases in some studies of gastric bypass patients. Remember to evaluate just how well your skin is tightening (or for that matter just how good a surgeon's results are for this sculpture), consider using my Standard Pictures for Loose Skin of the Male Chest which evolved specifically for this purpose. Even more critical are the videos, but they are harder to keep consistent between takes. Without that detail, you are not really tracking what things look like in real life, playing sports, and having fun with your body. If all that matters to you is how you look in one or 2 still photos standing upright, then ignore this additional information.

Knowledge is power about just what you have accomplished with your weight loss and how far you have been able to fill the loose skin with muscle, or just how effective someone's claims are to their method of treatment.

Hope this helps,

Michael Bermant, M.D.

[mooninite]

i forgot to ask this last time, but does the outcome of how the nipple look differ from patient to patient.  the majority of post op pictures seem to have people with flat and thin-looking nipples.  i know that they will shrink in size, but is the nipple always going to flat afterwards or will it still poke out a bit like it should?  does it just depend on the amount of gland removed?  of course awkward nipples are better than boobie sticking out, just want to know the costs (other than financially) of getting the surgery. 

seems like my nipple may sit a bit lower than ideal or not, chances of losing some sensation in nipple area, weird nipples, and about 7k for surgery; then there are the givens for any surgery.  a good surgeon is the best way to avoid these issues, and i'm liking what i hear and see with Dr. Delgado in SF.  still about a year away till i can afford it n if i'm not able to improve my situation enough first...at least i'll be in great shape when i do get the surgery.