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

Question

About me: 32 year old male (Height: 5 feet 9 inches | Weight: 200 LBS) I have a very severe case of gynecomastia and I'd like to know what are my options? I need the following: excess fat + gland removal from both sides, excess skin removal/tightening, reduction and repositioning of the areolas. One of the surgeons I spoke with recommended a male mastectomy with free nipple graft. I'd like to know if there's an alternative to the free nipple graft method.

J. Timothy Katzen, MD, FACS · Answer

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

Emmanuel Mallol Cotes, MD · Answer

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

Joel Patrick Maier, MD · Answer

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.

Mathew A. Plant, MD, FRCSC · Answer

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!

Earl Stephenson, Jr., MD, DDS, MBA · Answer

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

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

Answers (10)

Answer: I have a very severe case of gynecomastia. What are my options?

Answer: I have a very severe case of gynecomastia. What are my options?

Answer: Alternative is NOT a great option!

Answer: Alternative is NOT a great option!

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.

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

Answers (10)

Answer: I have a very severe case of gynecomastia. What are my options?

Answer: I have a very severe case of gynecomastia. What are my options?

Answer: Alternative is NOT a great option!

Answer: Alternative is NOT a great option!

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.