Would I benefit from a donut lift? (Photo)

Hello Brave 427239 in St. Louis. Thank you for your question about whether you need a donut mastopexy or male breast lift after a 100-pound weight loss. Thank you for your history and your pictures. Congratulations on your weight loss. Great job! First, let’s analyze your pictures. You have cutis pleonasmus (excess skin) and dermatocholosis (loose skin) without stretch marks (stria)
of the male chest. You have a Class 3 deformity of the male chest after massive weight loss. That means liposuction to the chest alone will not solve your excess skin and fat in the chest. Therefore, the skin and fat of the chest need to be removed. A donut mastopexy will not achieve optimal results. A donut mastopexy will only lift your breast and not remove much tissue; if your plastic surgeon plans to include liposuction, that may help a little. However, liposuction combined with a donut lift may jeopardize the blood supply to the nipple-areolar complex. A better solution for your Class 3 gynecomastia after massive weight loss would be a stealth or vertical incision torsoplasty or an infra-mammary fold torso plasty. During a stealth incision or vertical torsoplasty, an incision is made from the armpit down the side of the chest. During this procedure, a large elliptical area of skin and fat is removed, and the male breast is swept laterally. The benefit of this procedure is that the scars are hidden, and a significant amount of skin can be removed from the lateral chest wall. The downside of this procedure is that the nipple-areolar complex is displaced laterally. Due to this lateralization, the nipple-areolar complex needs to be shifted centrally. This can be done with a small horizontal dart incision or as a free nipple graft. A free nipple-areolar graft removes the nipple-areolar complex and returns like a postage stamp to the body. The appearance is perfectly adequate. However, the nerve supply to the nipple may be disrupted. Another benefit of the vertical torsoplasty is that the scars are concealed when your arms are at your sides. Another alternative to a Class 3 gynecomastia breast deformity after 100-pound weight loss would be an incision in the infra-mammary fold underneath the breast. The inframammary fold is where the chest wall meets the upper abdomen. When the incision is placed in the infra-mammary fold, tissue dissection is carried to the pectoralis muscle and then up to the clavicle. The excess breast skin is pulled down, and the skin between the infra-mammary fold and the nipple is removed. Often, a small pedicle is made for the nipple circulation. Alternatively, the nipple can be removed and returned as a postage stamp. The benefit of the free nipple-areolar graft is that more tissue can be removed, and the chest is flattened. If a pedicle is used for nipple blood supply, the pedicle can leave a bulky appearance on the chest. For your best results, most plastic surgeons experienced with massive weight loss would suggest an incision in your infra-mammary fold. The nipple-areolar complex would be removed and replaced as a free graft. If, however, you cannot deal with this highly visible scar on the chest wall in the infra-mammary fold, then proceed with the vertical or stealth midaxillary line torsoplasty for male breast reduction. Good luck. I hope I’ve answered your question regarding whether you would benefit from a donut lift for gynecomastia surgery after massive weight loss.
I hope I have answered your question regarding gynecomastia surgery and a donut mastopexy after 100 pound weight loss. If you have any more questions regarding gynecomastia surgery, male breast reduction surgery, liposuction for gynecomastia, donut mastopexy or male breast reduction after weight loss, contact an experienced plastic surgeon. Since gynecomastia surgery is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing gynecomastia surgery after massive weight loss. Do your research. Ensure they have performed at least 100 gynecomastia surgeries and have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. If you cannot find an experienced torsoplasty plastic surgeon in your neighborhood, consider traveling out of state. Sincerely, Dr. Katzen, MD, MBA, FICS, FACS. (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, and International College of Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Most peri-areolar lifts seem to be inadequate in meeting expectations and the skin gathers around the areola making for a odd appearance and sometimes they will stretch out. The more standard and maximum treatment would be a transverse elliptical excision of the lower breast skin/tissue with an areolar graft. There would be a transverse scar and there will be some degree of pigment loss in the areola from the grafting.

It’s difficult to assess your anatomic situation without doing a full physical exam. You may only need Vaser liposuction to remove chest fat and glandular tissue located below your areola region. The Vaser liposuction emits ultrasonic energy, creating heat waves that augment skin contraction. The Vaser, while shaping the underlying fat tissue and removing excess fat that your skin will contract enough without requiring a nipple lift and avoiding scars. You can always do a nipple lift in a delayed, secondary procedure if there is not enough skin contraction after the liposuction to meet your expectations. All the best!

HI,
In looking at your pictures it seems to me that a peri-areolar procedure would probably be insufficient to remove the excess skin (especially on your left side). You are a better candidate for complete resection of the excess tissue of the chest with scar placement in the shadow of the pectoralis muscle and nipple grafting to raise them higher on the chest wall. I perform a great deal of chest masculinization for transgender individuals and have seen many poor outcomes when surgeons try to minimize scars. Please feel free to peruse my web site before and after galleries to get an idea of the outcomes you can expect.

Regards,

Daniel A. Medalie, MD

Hello, The peri areolar procedure will leave a scar around the border of the areola and is able to tighten a certain amount of skin. It is difficult to remove as much skin as desired as the larger outer circle must be somewhat compatible with the inner, smaller diameter circle of the areola border. It's basically removing a strip of skin outside of the areolar border so that all of the skin on the chest will tighten. This only works to a certain degree.

The other option for patients who's a real areolae are close to the breast crease can undergo a complete tightening of the chest skin but a much longer scar in the chest crease. The nipple and the areola skin would be removed and then replaced in a aesthetically pleasing area but they will not have sensation or erectile function. The scar is long but it many patients it is the best option to avoid sagging skin on the chest after a less aggressive procedure. You may consider the peri areolar and understand there may be some limitation on tightening but is a reasonable choice considering you are not that "droopy". Best of luck.

Given your skin's limited capacity to contract after significant weight loss, a periareolar mastopexy might not be the most effective approach for you. This method relies on your skin's ability to shrink from a larger to a smaller circle, which could lead to disappointing results considering the additional breast tissue that needs to be removed, and that your skin has already maximized how much it can contract.

Instead, a more suitable option could be to make a horizontal incision in the lower breast fold to remove excess skin and breast tissue. This would keep the areola in its current position while tightening the surrounding skin for a more contoured appearance. In the final result, there would be a smooth incision around the areola, and a separate one in the lower breast crease. The presence of your chest hair could also help further by camouflaging the incisions.

Dr. B.

You would indeed need a doughnut lift and a tummy tuck operation. In our experience patients who experience massive weight loss need to get surgeries that cause bigger scars due to their sking having lost its elasticity. And we get better results from such operations.