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In the male bariatric surgery patient who has undergone massive weight loss, the resultant chest wall (breast) deformity is often of major concern. The appearance of the male chest, like the female breast, is of understandable significance. This male chest deformity is often called gynecomastia but this is inaccurate and actually signifies a different pathology. Gynecomastia is the enlargement of native breast tissue producing an enlarged nipple-areolar complex to a decent-sized breast. Chest deformity after massive weight loss is a deflation (loss of breast tissue) with resultant skin excess, sag, and a low-hanging nipple. As such, they are quite different from each other in many cases.

In some male bariatric patients, simple liposuction with or without a nipple lift, may be all that is needed. But in many cases, this is simply inadequate. The problem is what to do with the sagging skin and how to get the nipple positioned up higher on the chest……without creating a lot of scarring. (which may be worse than the original problem) In short, there are no easy answers to these issues.

Possibilities for correction include staged, repeat nipple lifts (each time inching it up higher), pectoral implants to add some volume (but you can’t have too much skin or this makes it look worse), or cut-outs of skin along the bottom part of the chest out to the side with the resultant scarring. Either way, getting the nipple up higher and removing excess skin often fights against each other.

Male chest ptosis (sagging) after massive weight loss is somewhat similar to that of the aging male’s chest problem. (but usually with less extra skin) Both are ‘deflation’ issues with low nipple positions. Most of the time a compromise has to be reached. Which is more important….tightening the skin or lifting the nipple? I usually encourage the male patient to avoid any significant scarring on their chest. While cut-outs of skin can very effectively tighten and lift the sagging chest, the resultant scars will usually make you feel no better about your chest problem. If your goal is only to look better in a shirt, then this might be an option. However, I caution the male patient about scarring. Even if they think it won’t matter, there is no magic eraser to take it away later.

As you can see, the male chest in massive weight loss poses a dilemma for many patients to which there is no easy solution in the extreme cases. A good in-depth discussion with your plastic surgeon is really needed here. The consequences of plastic surgery must be balanced against the original chest wall deformity to be certain that enough improvement can be obtained to make the surgical experience worthwhile.

Dr Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

While men still make up a relatively small minority of patients having plastic surgery and office-bsed cosmetic procedures (< 20%), those numbers have been steadily increasing since 2000. The top male cosmetic procedures in my experience include liposuction, rhinoplasty, gynecomastia reduction, and blepharoplasty.
It is no surprise that liposuction remains the top procedure for men given the large potential for fat collections in any one individual and that it can be done in both yong and old alike. Unlike women, however, most male liposuction is relegated to the abdomen, flank, and neck areas. Even in relatively lean individuals, flank fat collections are common as one ages. Today’s liposuction techniques have been refined to include etching procedures for those leaner males who want an easy way to the ’six-pack’ look.
Male rhinoplasty has been a mainstay for many years and remains a popular procedure for the teenage and young adult male. It is far less commonly performed in the older male over 40 who have come to accept their nose, no matter how disproportionate it is to other facial features, and would feel very ‘abnormal’ if it were changed at this point in their life. Rhinoplasty may frequently be performed with chin augmentation if it will improve their facial profile over a rhinoplasty alone.
Gynecomastia reduction is, in my opinion, the one male plastic surgery procedure that is on the rise. Whether it be a small protrusion of the nipple in a teenager, to a more traditional gynecomastia in adolescents, to a droopy and deflated appearance in the middle-aged male, improvement in the mae chest is now quite common.Liposuction, nipple lifting and reduction, and pectoral implants are potential methods for male chest enhancement. Refined liposuction techniques, known as etching, provides better definition to the pectoral outlines which can be combined with any of the other chest contouring procedures.
Eyelid surgery (blepharoplasty) in the male remains a common procedure. Most men wait until their eyelid problems are more severe than many women as some aging around the eyes is more accepted in men. There still remains the senior male who only has his upper eyelids done due to visual field obstruction.
Men increasingly are joining the Botox and Lipodissolve injection therapy ranks as well as having other traditional (e.g., facelift) and more exotic forms (e.g., pectoral or calf implants) of plastic surgery.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

I have been seeing more and more older male patients for ‘gyneomastia’ in the past several years. In the past, most of the males I saw with ‘chest problems’ were usually teenage boys who had the very typical adolescent form of gynecomastia. Some of these were quite small, isolated to the nipple-areola area, and others were quite large, having a B or C cup size breast equivalent to females. Surgical techniques included liposuction, open excision through the nipple, periareolar reduction methods, and rarely a more traditional form of breast reduction. These newer presentations of older gynecomastias (in reality, these are not really true gynecomastias but more accurately, pseudogynecomastias) present new challenges and require some adaptations to traditional gynecomastia approaches.
Some of these ‘newer’ gynecomastia are quite simple to treat. With the contemporary male model image of a very flat chest (I call it the Abercrombie Fitch look), some teenagers and men in their 20s and 30s want a small change in their chest contour by decreasing any projection of the nipple-areolar complex. Traditional liposuction, done aggressively under the nipple, works quite well for this small reduction. The next gynecomasia problem is in the overweight patient who has a large chest and small pseudo breasts. Liposuction, with or without a superior crescent nipple lift, helps the chest contour but the nipple never really gets as high up on the chest wall as we would like. Similarly, the male who has lost a lot of weight usually due to bariatric surgery, poses a difficult problem due to the excess hanging skin. Proper nipple position can never really be obtained in these patients without a lot of undesired scarring. Then there is the older male who has a combination of loose skin, low nipple position, and a ‘deflated’ chest appearance. Liposuction, nipple lifts, and occasionally pectoral implants can help rejuvenate the aged chest appearance.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Breast Reduction Surgery for Gynecomastia - Breast Enlargement in Males - in Indianapolis by Dr Barry Eppley

Breast reduction surgery is not just for women….although smaller in total number…..men get the procedure too! One of the most disturbing developments in a male is the development of breast mounds. This can occur during the male teenage years, when hormonal levels are changing, or when a man is older as a result of drugs, medications, or time and gravity. Rarely, although possible, is the development of breast enlargement secondary to an endocrine tumor or actual breast cancer. (about 1% of all breast cancers occur in men) Regardless of the cause, male breasts are psychologically very disturbing and often are visible through clothing. Many teenage boys, for example, will be reluctant to take a gym class or go to the pool in the summer for fear of ridicule. In older men, as popularized on the Seinfeld TV series, the concept of a ‘mansierre’ or a ‘bro’ garment is not too far fetched as the once proud chest area falls due to gravity and age.

The surgical treatment of male breast enlargement (gynecomastia) varies based on age and the type/amount of gynecomastia. In the teenage male patient, gynecomastia can be as slight as a protruding nipple area all the way up to an actual breast of a B or C cup size. We live today in an era of, what I call, the ‘Abercrombie Fitch look’, where the male teenager wants to have a smooth and very flat chest, including very little nipple projection. While most small gynecomastias resolve after a few years, if there is just a light residual nipple protrusion, the teenager wants it reduced. I have seen more and more of this over the past few years. These are simple to correct with a small incision at the bottom of the nipple and direct excision of the excess breast tissue. When the breast development is larger and the tissue is fairly soft, liposuction without the need for direct excision may be all that is needed. When the male breast is more like a female breast, however, these are the more difficult cases. The extra skin must be managed but without creating scars that run outside of the nipple. This type of ‘donut’ excision, with liposuction or direct excision, often requires several operations to get the best result. each time more skin is removed in the donut pattern until the chest area is fairly flat with the nipple in a more uplifted position. While it is possible to do these larger gynecomastias in one-stage with a large scar, all you are doing is trading off one undersired problem for another. The scarring will still have them self-conscious….and uncorrectable for a lifetime.

In older men, the gynecomastia problem is often quite different. It is more of a problem with saggy excess skin and less of a problem with a large amount of breast tissue. (sometimes) For these men, we must have a strategy to deal with the excess skin which often involves a donut excision pattern and a nipple lift, usually with liposuction to contour the chest. In some select patients, I have placed a pectoral implant with a nipple lift to provide better volume to a ‘deflated’ chest appearance. Either way, older male gynecomastia can eleiminate the need for that ‘manssiere’ or the ‘bro’.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis