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!