Asymmetric gynecomastia surgery done, Is the area still full? (photos)

Question

Hello, I underwent asymmetric gynecomastia surgery, suction was performed plus tissue removal using a pulling method, in my opinion the area is still full, what do you think

Daniel Barrett, MD · Answer

Dear Reliable5300,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Mats Hagstrom, MD (license on probation) · Answer

It would be helpful to know how long ago your procedure was performed. You can expect results to continue to change and improve for up to three months. By six weeks things are close to final and things typically don’t change much after three months.
There are three tissue variables that contribute to how the male chest looks.
They are fat, breast tissue and skin laxity.
Skin laxity was not addressed during the procedure and may explain your lack of a better outcome.
The best way to assess your outcome is to put the skin under tension and see what the underlying soft tissues look like.
Do that by taking one hour meta-time and stretching it behind your head. Doing that puts the pectoralis muscle and chest skin under tension and allows you to see the distribution of both breast glandular tissue and subcutaneous fat accurately. if you are symmetrical with the skin under tension but the asymmetry forms when you put your arms back down then your asymmetry is due to skin laxity.
If your asymmetry is due to insufficient removal of either fat or glandular breast tissue you’ll be able to see it and feel it with the skin and pectoralis muscle under tension.
Gynecomastia surgery is tricky and getting a perfect male torso appearance sometimes isn’t possible.
It’s a matter of degrees of improvement and differentiating individual candidacy for ideal outcomes.
Skin laxity is by far the hardest to treat and can contribute far more than people are aware of.
Age, weight loss or gynecomastia itself can all contribute to having a skin laxity or loss of skin elasticity.
Thank you for including proper before and after pictures.
My best guess is that this is probably pretty close to what your potential outcome is based on fairly substantial unilateral gynecomastia preoperatively.
When the potential outcome for a certain condition is limited it’s important for patients to know that the procedure was done well and correctly despite less than perfect outcomes.
In other words being in the hands of a different provider probably would not have made a big difference in outcome. The potential improvement was inherently limited due to skin laxity.
There are surgical procedures to address chest skin laxity but the scars are pretty unforgiving.
Considering it’s unilateral the scars would also be unilateral.
Most likely the procedure was done well with a relatively small chance the better outcome would have been obtained with a different provider.
To get an accurate assessment would require an in person consultation with an examination.
Gynecomastia surgery especially determining candidacy and predicting outcomes can be challenging.
It’s always helpful when surgeons have the experience to make accurate assessments and can communicate clearly what can and cannot be accomplished with the procedure during in person consultations.
It also helps if surgeons have the discipline to be honest and set expectations correctly well in advance.
Best,
Mats Hagstrom MD

Asymmetric gynecomastia surgery done, Is the area still full? (photos)

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