Do I need free nipple grafting and large incisions? (Photo)

I went to a see a plastic surgeon and he said my case of Gynecomastia was severe. He also said I would need free nipple grafting and that there were no other options for me. He went on to show pictures of cases he worked on and they all had the grafting and and two large gashes under the nipples. They were less noticeable on white patients. I just want to know if there are no other options for me. I don't want to spend over $7000 to get rid of embarrassing manboobs and gain embarrassing scars.

Doctor Answers 6

About the Gynecomastia Surgical Techniques

There are three types of surgical treatment options available that treat gynecomastia. The doctor will recommend the one that is best suited to each individual case. The excision technique is used on cases of #gynecomastia where excess skin and glandular breast tissue must be removed and the areola or nipple needs reduction and repositioning to create a natural looking appearance. The incision patterns are determined by the specific condition of the patient. The doctor will recommend this procedure which combines the liposuction technique and excision technique to create a natural look. Patients are given specific instructions for the recovery period. 

Men who suffer from large #areolas may notice that after breast surgery, the skin of the chest muscles will tighten, causing the areolas to tighten and diminish in size. This is a result of the removal of glandular and/or adipose tissue.The excision technique is used on cases of #gynecomastia where excess skin and glandular breast tissue must be removed and the areola or nipple needs reduction and repositioning to create a natural looking appearance. The incision patterns are determined by the specific condition of the patient. The doctor will recommend this procedure which combines the liposuction technique and excision technique to create a natural look. Patients are given specific instructions for the recovery period. 

Lastly, it is crucial you select a plastic surgeon who is #board-certified and has a great deal of experience with male breast #reduction. Plastic surgeons who have specialized in breast surgery and cosmetic surgery are suitable to perform your procedure. Aside from checking board-certification, it is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.


Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

Severe Gynecomastia

Hi stylesp,

Thanks for the post and photo. I will preface this by saying that an exact recommendation can't be given without an in person examination. That being said, you have several components to your gynecomastia that need to be addressed:

1) Large amount of tissue
2) Low nipple position
3) Enlarged areolas
4) Presumed skin laxity (this would need to be confirmed with physical exam)

In order to address all four of these components you will need more extensive incisions.  Free nipple grafts are an option. The nipples can also be left on a central mound of breast tissue. Although this doesn't reduce the amount of incisions, there is the advantage of having a higher chance of retaining nipple sensation.

Sincerely,

Dr. Dadvand

Babak Dadvand, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 39 reviews

Gynecomastia Tempa Florida FL

You have a very severe gynecomastia.The only solution is to see an expert otherwise you will waste your time and money and it may even look worse after surgery.If you can not afford it it is better not to have any surgery.

 How should I choose a surgeon?
Selecting a surgeon is as important a choice as the decision to undergo surgery. Choose carefully. The decision is yours. What follows is some advice to assist in making your selection.
1. Experience matters. Choosing a surgeon who has performed over one thousand gynecomastia cases increases the likelihood that they have seen a case similar to yours in the past. Selecting a surgeon whose practice is focused on gynecomastia exclusively is also an indicator of experience.
2. Results matter. The more before-and-after pictures a surgeon displays, the better. Pay attention not just to the number of pictures, but whether the surgeon is confident enough to show multiple angles of the same patient.
3. Reviews matter. Have patients reviewed your surgeon? Did those patients undergo the surgery you are considering?
4. Expertise matters. Is your surgeon recognized by the profession as an authority in the field? Are they certified by the American Board of Plastic Surgery? Have they authored books or medical journal articles regarding your surgery?
We hope these guidelines are of assistance when you are selecting your surgeon. When undergoing surgery, it is very important to be realistic about your expectations. Past results are not a guarantee of future results. Also, revision surgery tends to be significantly more difficult than initial surgery.

Mordcai Blau, MD
New York Plastic Surgeon
4.6 out of 5 stars 54 reviews

How to treat large gynecomastia

Your question is a good one, but unfortunately the solution is not an easy one to answer.  It would be improper to tell you what should be done without a full examination. I would suggest to you that some extensive  incisional pattern would be required to perform this operation.  Choose a good Plastic Surgeon and plan on having a serious consultation about what may be recommended.

Good luck to you.

Frank Rieger M.D.  Tampa Plastic Surgeon

Do I need free nipple grafting and large incisions?

That is one option. I just operated upon a more involved care that yours using simple mastectomies with pedicle N/A (NOT Free N/A grafts) results are terrific.. 

Scars in Gynecomastia

I agree with your surgeon that your gynecomastia is severe. Therefore, there is no method to reduce it without relatively long scars. There are several methods of doing the procedure, some not requiring a free nipple graft. However, placing the scar at the lower level of the present breast tissue with the nipple/areola higher, generally produces the most acceptable scar. The resultant scar depends on your skin and the method of closure. I generally close them with buried sutures that take about 6-9 months to absorb so the scar is mature before the sutures dissolve, thus helping assure as thin and inconspicuous a scar as possible.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 5 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.