This young man presents with an extreme case of changes in the upper chest and thorax from big time weight loss. He has maximal saggy breasts and lax skin with folds under his arms and across his chest. This happens in extreme weight loss patients. He is seen here about 7 months after his gynecomastia surgery procedure.
We have two issues to deal with. The first is his chest/breast area. This will require skin removal and relocation of the nipple/areola complexes. Second, I have to deal with the lax skin on his thorax/under his arms. Unlike the vast majority of “simple” gynecomastia cases, he requires skin removal on both sides. From a surgical perspective, I drew a pattern of skin removal from the middle of his chest to almost his back on both sides that would include the loose skin of his breasts and the surrounding chest. I managed the nipple/areola by using a lifeline of blood supply from the underlying tissue and move the nipple/areola complex on this tissue to the new location. The final scar shape is like this: _______O________________ . The O is the nipple areola complex and the line is the scar across his chest and under his arms.
His results are imperfect by my standards but no matter how you look at it there is a HUGE difference/change for the better. Look carefully as there is no longer loose skin anywhere on his upper chest and no breasts that are hanging down to his belly button. There is no skin fold on his lateral chest and under his arms.
It’s important to know that this case is an extreme gynecomastia treatment. In fact, it may fall more into the domain of weight loss surgery involving the chest and thorax. It is more complicated in its very nature, the recovery time is longer and it can have some significant problems. Probably the worst would be loss or death of the nipple-areola complexes that, although a disappointment, can be fixed to look quite normal afterwards. Under certain conditions, it would even be advisable to remove the nipple-areola complexes as FREE GRAFTS and simply put them where I want to place them without concern about blood flow from deeper potentially unreliable tissues. This is one of the most reliable procedures under the circumstances. In his case, I told him that I may have to do this during his procedure but I felt comfortable with the blood supply to the nipple-areolas during his case so it wasn’t necessary to use them as free grafts.
I’m grateful to this patient for allowing me to use his pictures. I know this will help others who are in a similar situation and what life could be like with proper treatment. This is a life changer for sure, in a lot of ways a bonus for losing all that weight to begin with! Can you imagine what it’s like to put on a shirt now compared to his old chest?
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