Need advice on surgery for my Gyne (see UPDATED pics)

[John16102]

My gyne condition is far more advanced than most of the pics i have seen on this site and I have questions the type of surgery i might need. With many of the pics that I saw today, I am sure the less invasive surgery would be used to correct but with mine, I am sure that I would need a procedure that would include visible scarring. Also, I am a good control diabetic with A1C avg of 6.0....wondering how this would affect surgery if any.

More about me: been Gyne since I am 16 and am now 48. Married to a beautiful woman who accepts me as I am and tells me not to have the surgery at this point in my life. Not to mention that she enjoys them when we are intimate in bed....:-) However, I would prefer to have a chest like a man.

Please look at my pics and advise your thoughts and if I will probably need the more invasive surgery.

Thanks,
John

ps: I have stretch marks from my nipples outward about 3 - 4". Not sure what role that plays with surgery?

OK, i revised my pics. I hope these give you a better view.

One more note, my boobs hang a lot when I bend over due to stretched skin that occured when I was teen. So much that my wife said that they look more like a woman's breast when I am in bent over position. This leads me to think that I will probably need skin tightening work.

[Ibanez99]

That is some good amount of gland there. However I'm not sure if this can all be excised through the areola incision. But most of it could be fat also,you never know. Your surgeon can come to know how much gland is there only after liposuction. (or after making incisions). I'm not really sure if the areola incision will work for this. Maybe a doctor could give you a proper answer here.
Sid

[balalayka]

Can you post clearer pictures ? Ones where your whole torso appears in the picture and some side shots ? If you're overweight, weight loss is recommended first before you go on with surgery. If there's some fat you can lose,then it will help with the final result. But I cannot really tell.
Now as for the surgery itself, you never know. Maybe the doctor can do it with less invasive surgery, I have seen before and after pictures which I never believed the doctors could pull off the result with less invasive surgery but they did. these guys are very skilled. The only one who can give you an answer for your question is a surgeon. He may ask you to post clearer pictures though.

[John16102]

With many of the pics that I saw on this site, I am sure the less invasive surgery would be used to correct but with mine, I am sure that I would need a procedure that would include visible scarring. I have stretch marks around nipples and sides fo chest so the skin is stretched. Also, I am a good control diabetic with A1C avg of 6.0....wondering how this would affect surgery if any.

Nipples- Can huge nipples be reduced and make them look more like a male's nipples?

More about me: been Gyne since I am 16 and am now 48. Married to a beautiful woman who accepts me as I am and tells me not to have the surgery at this point in my life. Not to mention that she enjoys them when we are intimate in bed....:-) However, I would prefer to have a chest like a man.

Please look at my pics and advise your thoughts and if I will probably need the more invasive surgery versus just lypo.

Thanks,
John

ps: I have stretch marks from my nipples outward about 3 - 4". Not sure what role that plays with surgery?

One more note, my boobs hang a lot when I bend over due to stretched skin that occured when I was teen. So much that my wife said that they look more like a woman's breast when I am in bent over position. This leads me to think that I will probably need skin tightening work.

[Dr. Elliot Jacobs]

Most men want a tight, contoured chest with virtually no scars at all.  That cannot happen in your case.  You are overweight and you have a large amount of asymmetric gyne and stretched out skin as well.  Your age (48) also means that you have lost some elasticity based on that alone.

When I have patients such as you, I sit down and have a frank discussion about their goals because there are basically two approaches to the problem.

A:  you can have minimal scar surgery with the anticipation that the breasts will be made much smaller and that the skin will tighten up to some extent -- but that extent is not predictable.  The net result would be much smaller breasts, minimal scars and most likely a residual fold on the lower aspect of your chest -- which looks quite natural (and quite acceptable) for a guy who is a bit overweight.  The slight difference in the location of the nipples would probably remain the same.  This approach would give you roughly an 75% or more improvement.

B:  a much more elaborate and longer operation which would re-position the nipples so they were symmetric, remove excess skin and of course deal with the excess breast tissue.  This would leave you with a much tighter and more contoured chest -- but with many more scars.  This procedure should increase the improvement to over 90% or more.  It is also much more expensive.

So it comes down to a decision on your part as to what your goals really are and whether you would accept something good but not quite perfect -- or if you want to go "for the gold.".

By the way, doing operation A does not preclude you from considering a small skin tightening procedure in the future if you still wanted more improvement.  In fact, the scars might be somewhat less because you would have given your body some time to tighten by itself -- thereby leaving less excess skin to deal with.

BTW, a Hemoglobin A1C of 6 is just fine and should not pose a problem for your surgery -- we operate on diabetics all the time.

And very large nipples (themselves, not the areola) can be reduced at the same time with either operation.

I hope this has given you some perspective on your problem.

Good luck!

Dr Jacobs

[balalayka]

My "non surgeon" opinion is maybe a doc can pull it off with less invasive surgery. Depending on how well your skin will retract. 

[Dr. Elliot Jacobs]

Most men want a tight, contoured chest with virtually no scars at all.  That cannot happen in your case.  You are overweight and you have a large amount of asymmetric gyne and stretched out skin as well.  Your age (48) also means that you have lost some elasticity based on that alone.

When I have patients such as you, I sit down and have a frank discussion about their goals because there are basically two approaches to the problem.

A:  you can have minimal scar surgery with the anticipation that the breasts will be made much smaller and that the skin will tighten up to some extent -- but that extent is not predictable.  The net result would be much smaller breasts, minimal scars and most likely a residual fold on the lower aspect of your chest -- which looks quite natural (and quite acceptable) for a guy who is a bit overweight.  The slight difference in the location of the nipples would probably remain the same.  This approach would give you roughly an 75% or more improvement.

B:  a much more elaborate and longer operation which would re-position the nipples so they were symmetric, remove excess skin and of course deal with the excess breast tissue.  This would leave you with a much tighter and more contoured chest -- but with many more scars.  This procedure should increase the improvement to over 90% or more.  It is also much more expensive.

So it comes down to a decision on your part as to what your goals really are and whether you would accept something  not quite perfect -- but perfectly acceptable -- or if you want to go "for the gold."

By the way, doing operation A does not preclude you from considering a small skin tightening procedure in the future if you still wanted more improvement.  In fact, the scars might be somewhat less because you would have given your body some time to tighten by itself -- thereby leaving less excess skin to deal with.

BTW, a Hemoglobin A1C of 6 is just fine and should not pose a problem for your surgery -- we operate on diabetics all the time.

I hope this has given you some perspective on your problem.

Good luck!

Dr Jacobs

[kingboob]

My "non surgeon" opinion is maybe a doc can pull it off with less invasive surgery. Depending on how well your skin will retract. 

I think Dr Jacobs is right....     

This guy is middle aged (no offense intended) and has stretched skin as well as gyne........... in order to get a flat chest he is going to need to get some skin tightening.    I had extreme gyne with loose skin...........  The choice that has to be made is  scars vs breasts.

Personally I would take the scars any day, but depending on how you scar it may not ever be possible to go around on beach shirtless without feeling uncomfortable.

 

[balalayka]

kingboob, of course Dr. Jacobs is right. I was just taking a guess 

[DrBermant]

My gyne condition is far more advanced than most of the pics i have seen on this site and I have questions the type of surgery i might need. With many of the pics that I saw today, I am sure the less invasive surgery would be used to correct but with mine, I am sure that I would need a procedure that would include visible scarring. Also, I am a good control diabetic with A1C avg of 6.0....wondering how this would affect surgery if any.

More about me: been Gyne since I am 16 and am now 48. Married to a beautiful woman who accepts me as I am and tells me not to have the surgery at this point in my life. Not to mention that she enjoys them when we are intimate in bed....:-) However, I would prefer to have a chest like a man.

Please look at my pics and advise your thoughts and if I will probably need the more invasive surgery.

Thanks,
John

ps: I have stretch marks from my nipples outward about 3 - 4". Not sure what role that plays with surgery?

OK, i revised my pics. I hope these give you a better view.

One more note, my boobs hang a lot when I bend over due to stretched skin that occured when I was teen. So much that my wife said that they look more like a woman's breast when I am in bent over position. This leads me to think that I will probably need skin tightening work.

Stretch marks are the scars from damaged skin support that has broken and is usually accompanied by lost elasticity and loose skin. The bending over views of my Standard Pictures to Evaluate Loose Skin of the Male Chest tend to show just how much loose skin is present. Low Nipples Look Weird on a Male Chest, much more visible from afar than scars. Options for any individual with a loose skin component depend on the amount of loose tissues, how low the nipples are, the skin elasticity, and many other factors.

A Skin Reduction Chest Lift can be a great compromise when done by an experienced surgeon who can demonstrate their skills with this challenging sculpture on men.

Stable diabetes in good control can have elective surgery, but can have a higher risk for infection. 

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia of Male Chest Ptosis - Sagging and Male Mastopexy Chest Lift Sculpture

[John16102]

Drs. Jacobs and Bermant,

Thank you so much for your input. It gives me a better idea of what I am dealing with.

I have one final question. Yes, I am overweight by 50lbs. I am 6'4" 280 lbs and my ideal weight is 230 lbs. Prior to surgery, is it best to lose the 50 lbs or does it even matter?

Thanks again for your info....I really appreciate it.

John

[Dr. Elliot Jacobs]

A simple and straightforward answer:  Yes, lose the weight first if you can.  We can then do a better job of evaluating you and making a recommendation for the best possible results.

Dr Jacobs

[DrBermant]

Drs. Jacobs and Bermant,

Thank you so much for your input. It gives me a better idea of what I am dealing with.

I have one final question. Yes, I am overweight by 50lbs. I am 6'4" 280 lbs and my ideal weight is 230 lbs. Prior to surgery, is it best to lose the 50 lbs or does it even matter?

Thanks again for your info....I really appreciate it.

John

For my patients, I advise them to get to a weight they are comfortable with before surgery. This becomes especially critical for the person with a  sagging chest. Losing weight can also result in loose skin. How well skin adopts to the new size can vary depending on many factors. Lift the chest with surgery. If you then lose weight, why do you think you will not droop again?

Unfortunately, weight loss after surgery is not predictable, you cannot pick where the weight goes on, nor where the weight comes off. Men tend to put fat first on the breast and belly. We take the fat off those regions last. If someone has their chest contoured even before weight loss, then loses weight in a normal male pattern and does not lose as much in the chest region, it can look like the breasts came back.

Losing weight can help with the fat of gynecomastia but does not help with remaining gland / scar tissue. I have seen many cases that losing weight that unmasks the remaining gland / scar tissue. Patients feel better about their bodies at the lower weight, but how the contour looks can be unpredictable.

As a surgical sculptor I prefer using a coarse tool first and then one of refinement. Losing weight is that coarse tool. Plastic Surgery is best reserved for refinement.

I also have had patients who lost weight after surgery. Some got away with it and were happy with their new contour. For others it came off in a fashion that left results less satisfactory, you just cannot predict. The unhappy patients were those from other doctors' prior surgery, and then had lost the weight. Most said they were upset that they had not been educated about such issues before surgery. Education is knowledge and puts the power with the patient. Although sometimes you can get away with it, or use revision surgery at additional cost, to me it seems just more logical to be patient and work on the weight first, then the surgery.

There is an exception to this format. The extreme athlete / bodybuilder. For these patients, I prefer to sculpt their off season weight. As body fat gets extremely low, healing can be impaired and there are few resources left to target gland first. A great example is this Competition Body Builder with Gynecomastia. Look at his body fat before surgery in his competition posing, the fat he had during surgery (obviously more), and the competition posing after surgery.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[John16102]

Dr. Jacobs and Bermmont,

Thanks again for the additional information. I am a student of whatever my focus is and right now it is gynecomastia surgery. So I need to get to work, drop 50 lbs and do more research.

If either of you have any additional info that you would like to share with me regarding my condition and the surgery, please feel free to contact me.

Thanks again,

John