Hello, and thank you for your question regarding erectile dysfunction following your tummy tuck and gynecomastia surgery. Thank you for providing your surgical history and the timeline of symptoms. While erectile dysfunction (ED) is not a common or expected complication after a tummy tuck or chest surgery, it can occur in rare cases due to nerve disruption, changes in body image, scarring, or psychological stress associated with surgery and recovery. My patients have never experienced erectile dysfunction after a tummy tuck and gynecomastia surgery. However, here are a few possibilities that may explain your symptoms: Nerve Irritation or Compression: During an abdominoplasty, especially if liposuction is performed in the mons pubis or groin region, small sensory nerves can be irritated or damaged. These include branches of the ilioinguinal, genitofemoral, or pudendal nerves, which can contribute to reduced sensation or altered nerve signaling, potentially affecting sexual function. However, these nerves are typically not involved in erectile function directly — their impact is usually more sensory than vascular or muscular. Reduced Blood Flow or Lymphatic Changes: Temporary changes in blood flow or lymphatic drainage to the genital region may occur following surgery, especially in procedures that involve extensive tissue removal or liposuction in the lower abdomen or pubic area. While rare, this could contribute to the sensation of diminished erectile strength. Psychological Impact: Many patients underestimate the emotional and psychological impact of body-altering surgery. Changes in appearance, lingering discomfort, or shifts in self-perception — especially around such personal areas — can trigger or worsen performance anxiety, depression, or body image issues. Since you mentioned you previously used medications like Viagra due to performance anxiety, it’s very possible that your ED could have a psychogenic component, now compounded by your surgical experience. Scarring or Tension in the Pubic Area: In some cases, a tummy tuck can cause pulling or tightness in the pubic region, especially if the scar line is placed too low or if the tissue is overly tightened. This could contribute to discomfort or restricted mobility during intimacy, which may in turn affect arousal or performance. Since Viagra and Cialis are no longer working as they once did, this suggests there may be more than just a vascular issue at play. I highly recommend the following: Schedule an appointment with a urologist to assess for any physical causes of ED, including vascular studies or hormonal evaluation. Speak with a psychosexual therapist or counselor, especially if anxiety or self-esteem may be contributing factors. Return to your plastic surgeon to discuss whether any nerve involvement or anatomical changes could be contributing to the issue. Most importantly, know that you are not alone, and help is available. With the right team — including your plastic surgeon, urologist, and possibly a mental health professional — you can identify the root cause and find a solution that restores both function and confidence. Sincerely, Dr. J. Timothy Katzen, MD, MBA, FASMBS, FICS