I have a very severe case of gynecomastia. What are my options? (Pohto)

Hello Compassionate520268 in Waterloo, and thank you for your question regarding severe gynecomastia and treatment options.

From examining your pictures and your description, it appears you require a formal male mastectomy. This procedure involves placing an incision beneath the breast to remove excess skin, fat, and glandular tissue. The nipple is then removed and repositioned as a free graft to achieve the best aesthetic outcome.

It’s important to understand that alternative approaches, such as liposuction alone or techniques that retain the nipple on a pedicle, will not achieve optimal results in your case. Liposuction alone would leave you with hanging breast skin, and a central pedicle technique would likely leave a noticeable mound of breast tissue, creating an “A cup” appearance.

If you have reservations about a free nipple graft, I encourage you to reconsider. In experienced hands, the success rate for this technique is approximately 99%. Nipple sensation often returns over time, and the free nipple graft allows precise positioning for a more natural, masculine chest contour. Anything less than a complete male mastectomy with a free nipple graft would compromise your results.

I hope this helps clarify your options and provides confidence in proceeding with the recommended surgery for the best outcome. Please consult with an experienced, board-certified plastic surgeon specializing in male gynecomastia for further guidance.

Sincerely,
J. Timothy Katzen, MD

Thanks so much for your inquire,

For severe cases of gynecomastia, surgery is often the most effective and permanent solution. The goal of surgery is to remove the excess glandular tissue and fat, and sometimes to reshape the chest to provide a more masculine and contoured appearance, that involves both significant glandular tissue and excess fat, a combination of glandular excision and liposuction may be the most effective approach.

Also, the areolas can become distorted, enlarged, or low-hanging. If this is the case, we may recommend an areola reduction (removing excess skin) or nipple repositioning to improve the overall aesthetic result. This can be performed alongside glandular excision and liposuction to achieve a more refined appearance.

A board-certified plastic surgeon with experience in gynecomastia surgery will be able to assess your case and develop a tailored treatment plan to meet your goals. If you have concerns about scarring, areola size, or nipple position, these can also be addressed during surgery to give you a more natural and masculine chest contour.

Sincerely,
Dr. Emmanuel Mallol

You will benefit from liposuction of the chest and bra roll/lateral chest wall are with a breast amputation with free nipple graft. In your case, anything lesser will not meet your expectations. You will have a transverse scare under each breast to achieve adequate skin/tissue removal.