Managing Excess Skin After Gynecomastia Surgery

Treatment for Gynecomastia Without Large Scars

After years of practice and thousands of satisfied patients, I have learned the diagnosis and treatment of gynecomastia is pretty straightforward. The treatment of gynecomastia is the same in almost all cases, except for those patients who have excess skin with saggy tissue. These patients sometimes require skin removal treatment, meaning I need to remove excess skin and reposition the nipple-areola complex. This is a much bigger procedure with a longer recovery, more cost, and scars across the chest, under the arms, and around the areolas. When necessary, this procedure can be life-changing, but it’s understandable that you want to know the alternatives.

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Patients who require skin excision usually have lost a LOT of weight — to the tune of 50 pounds and more. Their skin was maximally stretched when their weight was up. After weight loss, the skin can’t retract fully because it has lost its elasticity, or its ability to bounce back like a rubber band. But how do you know when skin excision is necessary?

The Gynecomastia Grey Zone

Like anything in life, when it comes to determining who needs skin excision, it isn’t black and white. This is what I refer to as the Gynecomastia Grey Zone. These patients appear to have skin laxity with a saggy look to the chest area. Often there is a history of significant weight loss. Many surgeons believe these patients will only respond to skin removal treatment, or they will be left with saggier skin than when they started.

“A nice chest without large, conspicuous scars.”

But the opposite is often true in my experience. I know now that there is an impressive capacity of the chest skin to retract, even when you wouldn’t have thought so on visual and physical examination. I have worked with many patients who have responded remarkably well to standard, non-skin removal treatment. The result was good skin retraction with a nice looking chest without large, conspicuous scars that are as obvious as day and night. Why have large scars across your chest that clearly indicate surgery when you can enjoy a positive result with a natural looking chest without scars?

How do I know who is going to respond well to my standard treatment? What happens if I don’t obtain the result that makes my patient happy? Experience matters when it comes to selecting those patients who I feel will succeed with standard treatment. The worst-case scenario is that we need to go back for a secondary procedure 1 year later to remove skin excess and shape up the chest area. This has proven to be very uncommon in my practice because I’m able to make a good decision regarding the best treatment for the individual patient.

Case Study: Excess Skin After Gynecomastia Surgery

excess skin after gynecomastia surgery - before and after photos

This patient picture collage says it all if you look carefully. This is an actual patient who I treated at the Austin Gynecomastia Center. He is seen here several months after the treatment of his significant gynecomastia. His case was not simple — he had lost some weight and his skin was not in the best condition. This made treatment more problematic, because a decision had to be made about treating him with standard, non-skin removal techniques or skin removal with scars across his chest.

The best thing about my vast experience with gynecomastia is that I’m able to make that decision with accuracy. I have learned how well the skin will respond to treatment when dealing with patients whose skin quality varies considerably. There are many cases I treat without skin removal when other surgeons would suggest skin removal is needed because of the sagging nature of the chest. I would feel terrible subjecting a patient to big scars across his chest when he didn’t need it. I have learned from my patients not to underestimate the ability of the chest skin to retract after gynecomastia treatment.

His skin has retracted very well. It’s not perfect but it is perfectly amazing considering where he came from. Isn’t it better to have a natural looking imperfection rather than large scars across the chest that clearly reveal an operation? Don’t get me wrong, I do operate on many patients who need skin excision, but these are always people who clearly need it. Again, the key to optimal treatment is to know when they need the more advanced, expensive, and complicated treatment of skin removal and nipple-areola relocation.

“Fix the body and the mind can follow.”

The biggest observation in this case is that he has lost weight and gotten into shape. Look at the change in his body. Look at what he has achieved. Realize this attitude was jumpstarted by the treatment of his gynecomastia, which freed him up to engage in positive behavior resulting in the changes you see. This is a very big deal! He has a positive body image now. Good things happen when you like your body. The first thing you’ll do every day is shower up and stand in front of the mirror because it’s sure nice to get the positive feedback of a rocking chest!

This case illustrates the mind-body connection. Fix the body and the mind can follow. As always, my hat’s off to all my patients who have taught me how to be a conscientious gynecomastia surgeon.

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Making the Right Choice

Why is all this so important to you? The answer is straightforward: You don’t want an inexperienced surgeon to recommend skin removal when you don’t need it. We can’t take those scars back — it’s one and done. It’s very hard for me to consult with patients who have had this open surgery with large scars and they simply didn’t need that form of treatment. That’s why I always recommend that you see several surgeons in consultation if anyone of them suggest open gynecomastia treatment with skin removal.

Robert Caridi, MD
Diplomate of the American Board of Plastic Surgery
Fellow of the American College of Surgeons (FACS)
Member of the American Society of Plastic Surgeons (ASPS)
Founder of the Austin Gynecomastia Center