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.

Excellent question. Mastectomy and free nipple graft is an option but kind of an extreme one. There will be other options that involve removal of all the gland and skin excess without completely detaching the nipple and grafting it. In person examination would be important and after being assessed a discussion can be had about the best scar pattern for the skin removal. See a few surgeons until one comes up with a plan you like. Best of luck!

Compassionate,

Thank you so much for being brave to post your pictures. This is a terrible problem for us guys. But there is a solution.

First and foremost, you can have another procedure that accomplishes the same in But in my opinion, it does not offer the contour and incisions to consistent with the male chest. That alternative procedure would be a breast lift type of incision that looks like an inverted "T". This reduces the areolar diameter and removes the excess skin as well the gland. Again, this is not the operation of choice, but is an alternative.

Your best option is, as your initial surgeon suggested, removal of excess skin and breast tissue, with a mastectomy, placing the incision in the natural crease between your chest upper abdomen. At the same operation, performance of a free nipple graft to position your nipple and reduce the diameter of the nipple appropriately for a male chest

I hope this was helpful.

Best wishes!
Earl Stephenson, capital Jr., MD, DDS, MBA,
ESJ Aesthetics,
#TruthAndTransformation

The surgeon you saw gave you a perfectly reasonable plan, but the procedure can be done without a free nipple graft. By keeping the nipple and areola attached to a piece of chest tissue (a "pedicle") it can be repositioned and reshaped without completely removing it as a graft. This method can also preserve the contractility and sensation of your nipple and areola.

Thank you for your question. For you as a thirty-two-year-old man with severe gynecomastia, your options will include a mastectomy with a nipple graft to remove the breast gland tissue, excess skin and to reposition the areolas to a more natural location on the chest, as well as liposuction to remove excess fat. To explore these choices, you should speak with a board-certified surgeon, as they can customize the surgical procedure to your unique anatomy and desired results. They will consider your overall health, your expectations for recovery, and variables including skin, glandular tissue, and extra fat.

You are an excellent candidate for double incision with free nipple graft. Best option for you and in my opinion the only option for optimal results.

The scar will fade. nipple will heal very well. It is very common in Los Angeles.. We do a lot.

Best to see a board certified plastic surgeon.

Good luck

Andrew Cohen, MD

You can’t do a lift and remove all the subcutaneous tissue at the same time without doing a free nipple graft.
There are going to be inherent limitations in regards to managing skin, laxity and successful treatment of gynecomastia, including removing glandular, tissue and fat.
If you remove all the subcutaneous tissues, then you can’t cut the skin or you will have to do a nipple graft.
This is fairly complex surgery.
Look for plastic surgeons, who have extensive experience with these type of procedures in the past.
Skin laxity is one of the reasons patients failed to get quality gynecomastia surgery outcomes.
Removing the excess skin is not compatible with the rest of gynecomastia surgery.
This is the reason why your surgeon is recommending, putting the nipple back as a graft.
If there was a simpler alternative, then we would all be doing it.
In the end, you need to ask yourself what you’re willing to go through and what you’re trying to achieve with this brand.
There is no easy solution.
Best,
Mats Hagstrom, MD