He came in on a Friday morning between a painter and a car negotiation. He had been almost two ninety back in 2017. He was down about a hundred pounds and going to the gym two or three times a week. And the chest had not moved.
I am publishing this consult nearly as it happened, identifiers removed, because men ask me these exact questions and almost nobody answers them out loud.
Him: This has been a thorn in my side since I was about 11 or 12 years old.
Me: “The problem is that we have a considerable amount of sagging. If I just did lipo, obviously you remove the volume, but it would still be sagging. So I don’t think you want that.”
Me: “Unfortunately, the trade off is the only way to do it is really with a scar. So I would have to put a scar right underneath the fold. And it would go to about here. And with that, I would be able to remove the tissue and the fat and the breast tissue, and then we would use the nipple. I would take it off completely, and then put it back on like a graft. Because I don’t think even with the tightening lasers, I don’t think it’s going to spring back. Especially this side.”
Him: How flat will it be?
Me: “It’ll be completely flat.”
Me: “And that’s why I recommend doing the lipo on the sides, because otherwise it’s going to look like you have a side breast. Because you won’t have anything here.”
The tummy tuck came with it
He had already been told he was a candidate. He was.
Me: “So you are a good candidate for a tummy tuck. The incision goes here. It will remove some of the fat on the mons and it’ll also lift it up. And the scar is going to go to where the fold ends. So it’s going to go to about right here where this fold ends.”
Me: “With that, we’ll be able to remove pretty much all the skin from here down. And then I’ll use this skin, and that’s the one we’re going to pull down. Look at your muscles. If there’s any separation, we’ll put them back together. But you’ll have a nice, tight, flat abdomen.”
Him: Does it make sense to do everything all together?
Me: “Yes. Because really the chest is not going to add any recovery. So you have that advantage of just that one recovery, and you’re done. Number one, it’s safe because we’re still under six hours, which is most important. And then it becomes a little less expensive, because the first hour of surgery is the most expensive.”
Me: “If we did it together, the surgery would be about four and a half to five hours, general anesthesia. It is in and out. You can go home the same day.”
Recovery, and the two drains
Me: “Recovery wise, you’re looking at about two weeks, mostly from the tummy, to get back to normal activity, driving, things like that. And then six weeks where you can go back to exercise, lifting, pretty much back to normal without any restrictions.”
Me: “We would have drains, both in the chest, one on each side. Those are going to come out pretty quick, four to seven days. Then the tummy, those can take a little longer. It could be seven to fourteen days.”
Me: “You’ll have your garments. I do recommend doing lymphatic massages. We have a tech here. And it helps get the swelling down a lot quicker, especially in the areas of liposuction. It helps avoid the fibrosis and bumpiness.”
The question men do not think to ask
Him: The only thing recovery wise I was concerned with, I have three dogs.
Me: “Do you have somebody to help you at home?”
Him: No.
Me: “So then is somebody going to bring you to the surgery?”
Him: I’d probably come by myself.
Me: “So then I would keep you overnight, because we can’t send you home like that. And then in the morning, we do have a service that can take you back home. My nurse will visit you the day after you stay overnight, to help you shower and how to take care of the drains and go over all the instructions again. You can extend those visits, or there’s also a third party we work with a lot that can keep coming in to check on you, and even help you with food and transportation.”
Me: “You would probably want to board your dogs for at least a while.”
Then, because it was true: “We had a male patient that had a facelift and we didn’t find out until after the surgery that he had 25 cats. So he would come to his post op and he would have scratches, and we were like, no. No.”
Why he was there at all
Him: I’ll go to the gym, but then I get really discouraged. I get to a certain point, like, oh, this is good. And then it’s not going to tighten.
Me: “We can take care of that for you.”
My exam note from that morning: bilateral gynecomastia, no dominant masses, ptosis worse on the right, right breast bigger than the left, a lot of excess skin and subcutaneous tissue in the lateral chest, abdomen, upper back and lower back, an abdominal pannus continuing laterally, and some degree of rectus diastasis.
The takeaway
Gynecomastia is not a weight problem and the gym does not fix it. If the skin has been stretched for twenty years, or stretched by a hundred pounds and then emptied, it will not recoil, and no laser changes that. On a chest with real sagging, the honest answer is a scar under the fold, and often a nipple graft. On a firm chest with fatty fullness, liposuction with skin tightening can be enough.
I am a double board-certified plastic surgeon, certified by both the American Board of Plastic Surgery and the American Board of Surgery, a Mayo Clinic fellowship alum, and I teach plastic surgery as a Clinical Associate Professor at Texas Tech University Health Sciences Center.
Ready to Talk?
If your chest has bothered you since you were a teenager, you have already waited long enough. Call the office at (915) 590-7900, text us at 1-866-814-0038, or book a consultation at drworldwide.com.
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