Male Breast Liposuction / Gynecomastia Surgery Information Resource for Southern California including Orange County, Newport Beach, Los Angeles, San Diego, and Beverly Hills.
Saggy Male Breasts
Treatin Saggy Gynecomastia
Up until now, we have discussed different types of gynecomastia based on what was causing the excess volume. Saggy gynecomastia introduces a whole new problem – excess skin. When there is excess skin the nipple will drop downward and be on the lower part of the chest tissue.
Gynecomastia can have 3 different components
- Excess breast tissue
- Excess fat
- Excess skin
Excess skin introduces a higher level of complexity because now we may be talking about skin removal. This usually requires a donut shaped incision around the areola. This incision essentially removes the excess skin from above and often below the areola. It not only raises the nipple/areola but also tightens the chest skin somewhat. See examplea of donut lift below.
Mild Saggy Gynecomastia – Notice how the nipples are no longer facing
forward and have dropped closer to the chest fold
Normally, the nipple is 4-6 cm above the chest fold. With Saggy Gynecomastia the nipple drops down closer to the chest fold and may even go below it in severe cases. Mild to moderate cases of Saggy Gynecomastia are often seen with aging and poor skin quality. Severe cases are usually associated with massive weight loss especially with gastric bypass or LapBand surgery.
Three Types of Saggy Gynecomastia
Mild
Moderate
Severe
Mild Saggy gynecomastia is when the nipples are approximately between 2-3 cm above the chest fold. Mild gynecomastia in a younger male has the potential to snap back when the excess volume of the chest is removed. In older individuals this snap back is not as likely. Skin quality is the big issue here.
Dr. Cruise prefers to not to do the donut skin removal on younger patients with mild saggy gynecomastia as they often do not need it. In older patients, however, a donut lift may be optimal depending on what the patient wants. The good news is that this small of a nipple/areola lift routinely does not leave a scar that can be detected. Putting the nipple back into its ideal position and tightening the skin makes the chest appear more youthful. Once again, this decision is completely up to the patient.
Donut Lifts on the Three Types of Saggy Gynecomastia
Mild
Moderate
Severe
Moderate cases are when the nipples are located somewhere between the level of the chest fold and 2 cm above the chest fold. Severe cases are when the nipples are below the chest fold. With moderate sagginess a donut lift is usually necessary to place the nipple/areola in proper position and tighten the lax chest skin. The donut lift is like a purse string that goes circularly around the incision. When tightened, the purse string suture makes the bigger circle into a smaller, elevated circle. This new circle is in the correct location and has the correct diameter of the areola. The areola is then sutured in place.
Tightening of the purse string suture may cause some rippling of the skin as the skin is compressed from a bigger circle to a smaller circle. These ripples will subside within a few months and flatten out in most cases depending on what degree of sagginess you have. With mild sagginess, there will be little rippling and it will go away quickly. With moderate sagginess, there will be some rippling post operatively but will most likely go away. Keep in mind, the donut lift incisions fall directly within the margins of the already darker colored areola. These incisions are extremely well hidden.
Severe Gynecomastia may or may not be treatable with a donut lift alone. Such a large donut lift may leave persistent rippling especially in surgeons who do not do gynecomastia surgery routinely. To avoid the rippling most plastic surgeons will treat the male breast lift much like a female breast lift and perform a full breast lift. A full breast lift leaves an anchor type incision that goes around the areola, down the chest to the chest fold, and then goes within the chest fold.
Dr. Cruise feels that these incisions are too obvious and typically does not do this type of lift. Instead, Dr. Cruise will carefully perform as large of a donut lift as safely possible based on his significant experience during the gynecomastia surgery. Typically this is all that is necessary. If there is still excess skin 6 months post operatively, he will perform only the horizontal incision within the chest fold so that there is no vertical scar down the chest. Keep in mind, severe saggy gynecomastia is typically seen only after massive weight loss.
| ______________________ | ________________________ |
| <<Fatty gynecomastia |
Gynecomastia Surgery / Liposuction Male Chest Information Resource for Southern California including Newport Beach, Orange County, Los Angeles, San Diego, and Beverly Hills.