Gynecomastia comes in various shapes and sizes. Surgeons have been educated that women with large or sagging breasts means a breast reduction or lift is necessary. What about a man who has something similar? Is the treatment removal and tightening of the skin with visible scars? Should surgeons approach the treatment of men and women similarly?
After performing thousands of gynecomastia cases, the answer is a resounding NO. There is a natural capacity for the skin of the chest to retract after tissue removal that I noticed and that I take advantage of for your benefit. Why have scars across your chest and around your areolas when they are not necessary? Having said that, there are some patients who benefit from skin removal and nipple repositioning, and the patient whose photos are attached with this blog speaks volumes.
The most likely candidate for skin removal is someone who has lost a LOT of weight—typically 75+ pounds. Overweight patients can also accumulate much fat in their chests, making it large and saggy. Ultimately, the decision as to whether skin removal is needed is based on skin examination and a very experienced surgeon who has been there countless times before and has learned, firsthand, how the skin has done after treatment.
In this case, this is a fit man who has localized sagging of his chest tissue. Although I felt it was possible to achieve a good result without skin removal (better positioning of his nipples and smaller areolas), he likely would have had some creases/folds of his skin. He decided he wanted skin removal, and you can see in his photographs that his chest is doing quite well with enhanced definition, smaller areolas (with some skin discoloration not uncommon after free nipple graft), and NO skin laxity or creases. His scars are doing quite well (he is only 4 months out, and the scars will get much better with time). He clearly “owns” his new chest, and his scars don’t diminish his mojo one bit.
The decision about skin removal is a joint one between you and me. I actually don’t have any problem doing skin removal, as patients overwhelmingly have been very pleased with the outcome. Men, in general, are not particularly scar-adverse. Scars take about 1.5 years to look their best. The use of silicone scar strips daily for many months improves scar appearance significantly. Flabby skin that hangs is clearly not attractive. A tight chest with an enhanced definition is a big bonus with skin removal gynecomastia surgery in the properly selected patient. And you can even see the benefits of MOTIVATION—check out his midsection!
Thanks to this patient for allowing me to share his case for all the world to learn from.
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