What is the Preferred Scarring Option for Severe Gynecomastia and Preferred Way to Move Nipples As Part of This Surgery?

Question

I lost over 100lbs and am now looking to do surgery for severe gynecomastia. I have consulted with many plastic surgeons and have been given many options. Is i it better to make scares in the inframmamry crease or the "lollipop" procedure for men with my condition? What about moving nipples, is it better to graft or keep them connected to the blood supply? Also, one doc told me scars could go "into the armpit" -- is this the same thing as making scars in the inframmary area or something else?

David J. Levens, MD · Answer

There are many different approaches to gynecomastia treatment associated with massive weight loss.  While more typical correction with relatively normal skin involves removing only the underlying glandular tissue and fat, if present, your massive weight loss (congratulations) obligates some reduction of the excess skin and usually repositioning of the nipple/areola.

	The goals are minimizing the scar length and visibility, preserving circulation and sensation to the nipple/areola and proper positioning of the nipple areola.

	All of the approaches you mentioned are good choices.  You should consult with a plastic surgeon to decide which is best for you.

Kenneth Hughes, MD · Answer

Gynecomastia with a loose skin envelope can involve removal of skin from the inframammary fold and transposition of the nipple areola complex while attached to a pedicle.  This provides for a more normal looking areola than with a skin graft as pigmentation changes can occur.  You will not need a lollipop as you do not have female breasts, and you do not want to improve the projection of the breasts.  You just need to find an expert who can easily execute this plan and answer all of your questions.  Kenneth Hughes, MD Los Angeles, CA

Tal T. Roudner, MD, FACS · Answer

Depending on the amount of breast tissue, fat and skin excess a plan for surgery is made. With young elastic skin smaller incisions and excisions are possible. A semi-circular peri-areolar incision for minimal excess tissue and minimal excess skin. A full peri-areolar for more significant excess breast tissue and minimal to moderate excess skin. And a infra-mammary fold incision as well as a transposition of the nipple areolar complex on a pedical or a breast mound to its new position. If there is massive weight lose and very lose skin with excess in the lateral part of the breast a breast reduction with a anchor incision maybe needed.

	 

	Good luck!

Barry L. Eppley, MD, DMD · Answer

It is hard to comment without seeing pictures. But in severe chest sagging after weight loss, an inframammary excisional  approach with nipple transposition (keeping it attached to the remaining breast tissue) can be a good techique. This obviates the need for the vertical scar between the new position of the nipple and the fold (as in the lollipop method) while keeping the blood supply to the nipple intact so it does not depigment like a free nipple graft would.

George J. Beraka, MD (retired) · Answer

Hi.

	1)  You see, you are trying to get rid of the illusion of "breasts".  If after surgery, your chest has nipples with curving lines in the inframammary folds (the scars), to the eye this picture looks like "breasts", even if you are flat!

	2)  Most men who need skin reduction with gynecomastia correction can get away with just a circular scar around the smaller nipples.

	3)  Of course, we always try to minimize scars.  But in the few men with SEVERE skin excess (you may be in this group), it is best to use a mastectomy approach.  This leaves you with scars at the level of the nipples. The nipples, used as free grafts, are sewn on to cover the center of the scars (free grafts don't work if you are African-American, because you lose the pigment).  This approach can leave you with noticeable scars (specially if you are not hairy), but at least these scars don't suggest "breasts".  And you will be flat.

	4)  Any gynecomastia plan that is based on analogy with female breast surgery (like lollipop scars) is seriously misguided, in my opinion. Hope this is helpful.  And forget about armpit scars.  Good luck!

What is the Preferred Scarring Option for Severe Gynecomastia and Preferred Way to Move Nipples As Part of This Surgery?

Answers (5)

Answer: Inframammary Excision with Nipple Transposition for Severe Male Chest Sag

Answer: Inframammary Excision with Nipple Transposition for Severe Male Chest Sag

Answer: Inframammary scar very bad for men with gynecomastia.

Answer: Inframammary scar very bad for men with gynecomastia.

Recommended reading

Everything you need to know about Gynecomastia Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.

What is the Preferred Scarring Option for Severe Gynecomastia and Preferred Way to Move Nipples As Part of This Surgery?

Answers (5)

Answer: Inframammary Excision with Nipple Transposition for Severe Male Chest Sag

Answer: Inframammary Excision with Nipple Transposition for Severe Male Chest Sag

Answer: Inframammary scar very bad for men with gynecomastia.

Answer: Inframammary scar very bad for men with gynecomastia.

Browse related questions

Recommended reading

Everything you need to know about Gynecomastia Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.