Donut vs gland-only in moderate gynecomastia? (Photos)

Question

I’m a 28-year-old male with moderate gynecomastia. No significant nipple ptosis and skin elasticity seems good. One surgeon recommends circumareolar (donut) skin excision to prevent potential nipple droop after gland removal. I was expecting a standard subcutaneous mastectomy via inferior periareolar incision, possibly with some liposuction, but without skin removal. In cases like this, is circumareolar excision typically necessary, or is gland excision alone often sufficient?

Zoran Potparic, MD · Answer

Based on these photos, it looks s very likely that aggressive liposuction and gland excision if needed may be sufficient. No skin excision seems to be needed. Good luck.

Laura Roider, MD · Answer

Thank you for sharing your photos! You have mild excess skin but good skin quality over the breast region. I would recommend considering gynecomastia surgery via liposuction and direct excision (through a small incision at the areola border). In addition to this, I would consider adding on a skin tightening device such as renuvion to help manage the excess skin you have. Personally, I don't feel that it is necessary to directly excise skin

Ramiro Morales, Jr., MD · Answer

Thank you for your question and pictures.  Without examining you it is difficult to know if you would need lipo.  That is something easy to determine by examination.  I would however say that I would do a subcut mastectomy/correction of your gynecomastia via a lower periareolar incision and based on your young age and good quality appearing skin, it should shrink up nicely without the donut skin excision.  Worst case scenario, IF the skin does not shrink enough after a few months then the donut can easily be done in an office setting under local anesthesia.  Be sure that your PS uses drains and also a compression vest for at least 6 weeks and be sure to see a Board-Certified PS for your consultation.

Jacob Carlson, MD · Answer

You have obviously done quite a bit of research on this top, so props to you for that. The circumareolar incision isn't wrong, but based on the photos you submitted, I wouldn't anticipate that you're going to have a lot of excess skin that would need to be removed. Assuming you are young, healthy, non-smoker, etc., then I think your skin will have the elasticity to retract back down very well.
Obviously performing a physical examination would be the best way to determine what interventions would be best for you. If its just soft, fatty tissue that can be addressed with liposuction, that may be a great option. If there is firm, glandular tissue present that needs to be excised, I would say that excision via an inferior periareolar incision +/- liposuction and radiofrequency (Bodytite, Renuvion, etc.) would be a very reasonable approach. I personally prefer that approach, because it's easier to conceal an inferior periareolar scar in the border of the areola than it is to conceal a circular scar all the way around.
Your surgeon is correct in that, if the tissue directly below the areola is removed, it cause the areola to scar down into a very flat or even concave shape. It's great that your surgeon is already thinking about that beforehand.
Regardless of which option you do, I would recommend following your surgeon's post-op restrictions and wear compression garments in the post-op period.

Darryl J. Blinski, MD · Answer

Based on the posted photos I would offer a combination of gland excision with Lipo reduction and sculpting. Fee from $6,000-$10,000. Best to virtual consult for more explanation.

Donut vs gland-only in moderate gynecomastia? (Photos)

Answers (5)

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