Sagging Male Chest Skin Without Gynecomastia? (photo)

Your issue may be less common than run of the mill gynecomastia, but it is progressively more common in this era of massive weight loss, and most surgeons who are operating on such patients will have experience.

I concur that it is wise to wait until you have reached your desired weight, as it is possible that 40 more pounds of loss will leave your with more skin excess than you have now. 

The procedure of choice will probably involve excision of the excess skin, and a variety of incision patterns can be used, and the choice will be based on the findings on physical examination during the consultation process. My guess based solely upon the current photo would be that there would be an incision around the nipple and areola to reposition it higher on the chest, and another that follows approximately the lower hairline on the chest, and continues onto the side of your chest, unless that fullness on the sides is bulging fat and not excess skin, something I cannot tell from the photo alone. 

While it may be not the time for surgery, it is not too early to begin the consultation process so that you have time to consider the options. When you are ready for an in person consultation, RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S. Thank you for your question, best wishes.

Congratulations on having lost 200 pounds. That is fantastic. My hat is off to you.Weight loss of this magnitude must have taken a significant amount of time and commitment.
The condition that you have is not uncommon after massive weight loss. What has happened is you lost so much weight that all your breast fat has disappeared.This is a subset type of gynecomastia; basically, you have gynecomastia without the fat. Your male skin breast has tried to recoil. However, the elastic fibers in the male breast skin can only do so much. The skin in your breast has tried to shrink wrap around the loss of fat as much as possible, but you are left with roll of skin. This roll or fold is called the inframammary fold.
I would suggest a male breast reduction. In your case, this is accomplished by making an incision underneath the inframammary fold. Typically, this is done by making an incision just underneath the breast fold. If the fold extends to the sternum, the incision need to go to the sternum. Typically, the incision then follows that skinfold toward what is called the mid axillary line. The mid axillary line is line drawn from the armpit to the hip. If you have excess skin and fat in this region, there are two options. The direction of the incision is changed and the incision is made towards the armpit. The convenience of this procedure is that the scar is more concealed. The other option is to extend the breast incision onto the back. The benefit of this procedure is that it can eliminate skin and fat from the breast, torso, and upper back. The downside of this incision is that it is more visible. Either way, both incisions result in what is called a torsoplasty.
During gynecomastia surgery, there are a variety of ways to treat the male nipple. Some plastic surgeons remove the nipple and re-attach the nipple as a free graft. Other plastic surgeons, like myself, prefer to preserve the male nipple blood supply and nerve supply. The male nipple is left attached to its blood and nerve supply and is initially buried underneath the skin flap. Then, the nipple is brought out on the new male breast like a button.
Again congratulations on your massive weight loss and good luck with your plastic surgery journey.

Sincerely,

Dr. Katzen

  This is fairly common, and I deal with this issue on a fairly regular basis.  You will need to remove the skin inferiorly and then place your areola at a more favorable position.  This can be done in about 1 to 1.5 hrs.  Find the plastic surgeon with ELITE credentials who performs hundreds of body contouring procedures each year.  Kenneth Hughes, MD Los Angeles, CA

You do have signficant excess skin of the chest.  You will likely need removal of this skin and movement of your nipple and areola into a higher position.  There are various techniques to do this and it is difficult to ascertain the type of surgery you will need without examining you.  If you are planning to lose additional weight, I would delay surgery until then.  However, you could have a consult now so that you would know more details about the recovery from surgery, the location of scars, cost, etc. so you could make a decision on whether this surgery is right for you.  Please seek out a board certified plastic surgery who is experienced in post bariatric body contouring.

Congratulations for your weight loss!  If you still have 30-40 pounds to go then obviously wait until that point to  have surgery.  Treatment of your issue will likely require skin excision and elevation of the nipples. Good luck.

Gynecomastia correction after massive weight loss is common for surgeons treating bariatric patiets. It would require removal of the gynecomastia and the excess skin and is best performed after loosing all the weight. There will be significant scars is exchange for skin that spans tightly across the Pectoralis muscle.