Loose Skin After Gynecomastia SurgeryAustin Gynecomastia Center

Since establishing the Austin Gynecomastia Center many years ago, I have learned quite a lot about the diagnosis and treatment of gynecomastia, a benign but very troubling male condition. Surgery for gynecomastia in Austin was presented in my formal plastic surgical training in a confusing, somewhat subjective and arbitrary way. There were several classifications and algorithms that attempted to determine which form of treatment was best for the many varied presentations of gynecomastia.

Fortunately, through my experience I discovered that most forms of gynecomastia can be treated successfully in the same way with few complications and impressive results. It is actually quite straightforward and relatively easy! I have found that the a more challenging aspect of gynecomastia surgery is determining which patients would benefit from skin removal and relocation of the nipple-areola complexes to prevent loose skin after gynecomastia surgery.

To briefly review, the state-of-the-art treatment of gynecomastia consists of two small incisions, one typically in the axillary hair (underarm) and the other at the bottom of the areola border. Through these incisions and with the use of VASER™ ultrasonic liposuction, I’m able to effectively treat a majority of patients regardless of size or appearance.

Illustration showing when skin excision is needed and when skin excision is not needed during gynecomastia surgery as well as the scars associated with each case.

Open and Closed Gynecomastia Surgery

However, one category of patients that posed a challenge where those with very loose skin and an advanced case of gynecomastia. In these cases, standard treatment would not result in a satisfactory result as there was excess skin with wrinkling and folds due to poor skin elasticity (the ability of the skin to contract or tighten). These cases required skin excision across the chest and typically under the arms, with relocation of the nipple-areola complexes to the ideal position on the chest.

This led to the development of the concept of “open” and “closed” gynecomastia treatment. Open gynecomastia surgery involves the removal of skin and tissue and relocation of the nipple-areola complexes, which produces large scars across the chest and under the arms if needed. Closed gynecomastia surgery refers to the treatment of gynecomastia with minimal incisions and virtually no scarring.

Is Open or Closed Gynecomastia Surgery Needed?

As always, experience matters most in making this important decision. After operating on thousands of gynecomastia patients, it has become clear who needs an open approach and, more importantly, knowing who didn’t need the open approach! Permanent scars across the chest that could have been avoided is the last thing any patient wants. In fact, one of the most important skills I have learned is how to judge when a patient does not need skin removal, despite when many of my colleagues would likely suggest an open approach. The ability of the chest skin to retract to a normal or near-normal appearance should not be underestimated!

How a free nipple graft works, part of open / skin removal gynecomastia surgery.

Patients who are more likely to need skin removal for loose skin after gynecomastia surgery are those with very large and saggy breasts. Often massive weight loss patients (over 100 pounds) need skin removal because there simply is no elasticity left in the skin and it simply won’t retract and redistribute after tissue removal. Age also affects skin elasticity, so older patients may need to have skin excised. Some of the ancillary techniques that I use, such as quilting sutures or wide undermining, have worked well to assist in skin redistribution after more challenging cases that help avoid the open approach.