Thanks for your question.The treatment of gynecomastia can start with liposuction of the chest and can work up to full surgical excision of the breast gland (if necessary). Typical surgery times range from 1-2 hours. I find that liposuction accompanied by a small surgical excision of tissue under the nipple is usually sufficient for 75% of my gynecomastia patients. I tend to use UAL (ultrasonic liposuction) because it helps to tighten the skin. In your case, I do worry that that would not be sufficient. A complete peri-areolar approach with peri-areolar mastopexy (skin tightening) is probably necessary in your case to prevent sagging of the breast tissue after the excision of the fat and gland. You do have hair on your chest which will help hide the scars somewhat. I hope this helps.
Daniel Medalie, MD
Thank you for the pictures.
I recommend UL liposuction on both breast, this technique melts the fat cells before being removed and tighten your skin about 30%, leaving less skin laxity.
looks like there is still a good bit of fat present and not just loose skin. I would be conservative with this and do liposuction only and it's remarkable how much skin shrinkage may take place. You could always go back as a second procedure a year or two later and do some type of skin removal but I will bet against it.
You would probably need some excision to firm up the area, and that would require an incision. However, you can try Smartlipo to see if the skin will retract as much as you'd like. No incision around the areola is necessary for this.
You are going to have to decide what is most important to you. The only way to tighten excess skin is to remove it. This necessitates having a scar. The more skin removed, the bigger the scar. A circumareolar skin excision will help. But the procedure has limitations. The amount of skin removed is limited and therefore the amount of skin tightening is limited. The scar with this procedure is also difficult to fully predict. Some patients have very thin scars that heal very well, but many patients end up with disappointing scars with this procedure. It would be a risk that you would have to be willing to take.
I believe that you would do best with a peri areolar skin excision. Your skin already is a bit droopy and I don't think it will tighten up more on it's own after the breast tissue has been removed. Good luck.