36 Thank you for your question regarding how your best results would be obtained with plastic surgery. You only included one picture which really only depicts the back. I can only predict from the front that an abdominoplasty or tummy tuck would be a great option. Also, I can only guess from the reflection of your covered chest in the mirror that gynecomastia surgery would be best. Since you have excess skin on the chest, I would suggest a formal breast reduction. This would mean an incision around the areola, down the front of the breast, and underneath the breast where the breast meets the chest wall. This is in the inframammary fold. Specifically, it should be communicated to an incision that goes completely across your back. This procedure is depicted on my website and multiple youtube videos. It is called a horizontal thoracoplasty. This is certainly indicated by the picture you've attached. In terms of planning, I'd suggest you have your tummy tuck or abdominoplasty performed first. Your tummy tuck should take about 3-4 hours to complete. Plan on a 2-week recovery and then plan for your upper body about 1-2 months after. That would include gynecomastia surgery which will include breast reduction and a horizontal torsoplasty with an incision across your back to take care of excess skin and fat across your back. The horizontal torsoplasty takes approximately 2-3 hours to complete. Breast reduction would take about 3-4 hours to complete. These procedures are often combined. Please allow for a 2-week recovery. Please seek an experienced board-certified plastic surgeon when contemplating combining these procedures. Thank you for your question regarding a tummy tuck, breast reduction for gynecomastia, and a horizontal torsoplasty or back lift for excess skin of the back. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)