Sagging Male Chest Skin Without Gynecomastia? (photo)

Congratulations on having lost 200 pounds. That is fantastic. My hat is off to you.Weight loss of this magnitude must have taken a significant amount of time and commitment.
The condition that you have is not uncommon after massive weight loss. What has happened is you lost so much weight that all your breast fat has disappeared.This is a subset type of gynecomastia; basically, you have gynecomastia without the fat. Your male skin breast has tried to recoil. However, the elastic fibers in the male breast skin can only do so much. The skin in your breast has tried to shrink wrap around the loss of fat as much as possible, but you are left with roll of skin. This roll or fold is called the inframammary fold.
I would suggest a male breast reduction. In your case, this is accomplished by making an incision underneath the inframammary fold. Typically, this is done by making an incision just underneath the breast fold. If the fold extends to the sternum, the incision need to go to the sternum. Typically, the incision then follows that skinfold toward what is called the mid axillary line. The mid axillary line is line drawn from the armpit to the hip. If you have excess skin and fat in this region, there are two options. The direction of the incision is changed and the incision is made towards the armpit. The convenience of this procedure is that the scar is more concealed. The other option is to extend the breast incision onto the back. The benefit of this procedure is that it can eliminate skin and fat from the breast, torso, and upper back. The downside of this incision is that it is more visible. Either way, both incisions result in what is called a torsoplasty.
During gynecomastia surgery, there are a variety of ways to treat the male nipple. Some plastic surgeons remove the nipple and re-attach the nipple as a free graft. Other plastic surgeons, like myself, prefer to preserve the male nipple blood supply and nerve supply. The male nipple is left attached to its blood and nerve supply and is initially buried underneath the skin flap. Then, the nipple is brought out on the new male breast like a button.
Again congratulations on your massive weight loss and good luck with your plastic surgery journey.
Sincerely,
Dr. Katzen

  This is fairly common, and I deal with this issue on a fairly regular basis.  You will need to remove the skin inferiorly and then place your areola at a more favorable position.  This can be done in about 1 to 1.5 hrs.  Find the plastic surgeon with ELITE credentials who performs hundreds of body contouring procedures each year.  Kenneth Hughes, MD Los Angeles, CA