Gynecomastia Surgery Gallery Plastic Surgery in Austin | Patient 98

Patient Details

This is the perfect gynecomastia case to learn about the limitations of gynecomastia surgery and to address the issue of realistic expectations.

This patient is in his late thirties. He had lost a fair amount of weight and complained about his chest and abdominal area. You can see from the pre-operative pictures that he had saggy skin of the chest area (what we call ptosis). His skin, on examination, didn’t have a lot of elasticity (this is the tendency of stretched skin to retract back to where it came from).

I told him he basically had three choices with treatment. One option is to live with what he has and save his money and no risk involved with this option. The second choice is for my standard treatment – gynecomastia surgery with Vaser and tissue removal – and expect imperfect but probably pretty good results. The third option is skin removal across the chest on both sides. This procedure will remove the skin excess and tissue but at the expense of these generous scars in a young man.

In his case we chose the second option. Doing nothing about his chest was a nonstarter. He clearly wasn’t happy with the appearance of his chest and looked forward to a day when he didn’t have skin excess, fullness and hanging skin. We also discussed the option that he could come on back after treatment and get skin removal as a secondary procedure – we treat him as usual and if he wasn’t pleased with how well the skin retracted we can do a skin excision (and the scar would be shorter because of his prior treatment and skin retraction).

You can see the photos of the masses that I removed. This was the stuffing in his pillow that was causing the skin to droop – it was like carrying heavy objects in a thin plastic grocery bag that will stretch and sag over time.

This case illustrates the reality of gynecomastia treatment in patients with marginal skin. It’s important to actually see these results as they may help you to make the best decision for yourself. Remember that many inexperienced surgeons will often underestimate the capacity for skin to retract after expert gynecomastia treatment – avoiding scars across the chest that are very noticeable. Remember too that I often remove skin when it is in excess and clearly (in my experience) needs to be removed as it will almost assuredly hang after treatment.

You can see the outline of his pectoral muscles and observe the improvement in the shape of his chest. Look at the side view where the skin hangs off of the bottom of his chest muscle and in the post-operative photos it is stuck down to the muscle and there is no hanging whatsoever.

It’s not perfect. There are some creases and irregularities for sure. I would call this a triple for sure. Not a home run but a really nice improvement without calling out the big gun repair of gynecomastia with skin excision.

What do you think? Would you prefer scars across your chest or the result you see if this where you?

I am very honest with my patients when it comes to results. I’m not here to show you nothing but the best outcomes, although honestly I am very proud of this outcome even though it’s not perfect. Welcome to reality. Reality can be quite good indeed!