Surgical Procedures for Gynecomastia with Hanging Nipples After Significant Weight Loss

Surgical Procedures for Gynecomastia with Hanging Nipples After Significant Weight Loss...

After significant weight loss (70-100lb+), guys may experience changes in chest contour, including sagging or hanging nipples.....

Why do you have hanging nipples?

After significant weight loss (70-100lb+), guys may experience changes in chest contour, including sagging or hanging nipples. This can result from the loss of skin elasticity and sagging volume, leading to excess skin and poor nipple position. Surgical intervention can restore a more masculine and aesthetically pleasing chest appearance.

Surgery Options:

1. Gynecomastia Excision Only

Indication:
This procedure is typically indicated for males with glandular breast tissue contributing to the appearance of gynecomastia. The nipple position is very close to normal. The chest skin may have normal elasticity or slightly loose.(Figure 1) This is also an option for teens who present with gynecomastia and weight loss who have retained skin elasticity or have not completed growth. (Figure 1)

Procedure:
Incision: A small 2cm incision is made at the base of the areola (from the 4-8 o’clock position)
Tissue Removal: Excess glandular or fatty breast tissue is removed leaving the normal fatty tissue padding under the skin.
Nipple Positioning: Because the nipple has remained close to the normal position, no nipple repositioning is needed,

Fig. 1

Fig. 2

2- Gynecomastia Excision with Renuvion (skin tightening)

Indication:
After removing excess glandular or fatty breast tissue, the chest skin is treated with Renuvion from the nipple incision. (Figure 3)

Procedure:
Technique: Fatty breast tissue is removed using small cannulas to make tunnels between the skin and chest muscle. These tunnels are used for the Renuvion probe to introduce controlled heat energy to the ligaments that attach the skin to the chest. The entire anterior chest to the clavicles is treated.
Contour: The goal of using Renuvion is to “tighten” the skin on the chest to improve the contour. Renuvion is best with “loose skin” that has retained some elasticity.

Fig. 3

3- Nipple Lift (Mastopexy)

Indication:
For males experiencing significant nipple ptosis, a nipple lift can be performed to reposition the nipple and areola to a higher, more natural position.

Procedure:
Periareolar Lift: This procedure can remove a limited amount of excess skin and reposition the nipple slightly higher to a more appropriate position. An incision is made around the areola, allowing the surgeon to remove excess skin and reposition the nipple. (Figure 4)
Double Incision Procedure: This is the procedure that can remove a large amount of excess skin after weight loss. The skin is removed in a horizontal elliptical pattern that continues into the axilla or lateral chest. The scar is placed in the chest crease. The nipple is removed and grafted onto the chest in a more aesthetically appropriate position.
Keyhole Procedure preserving nipple sensation: This procedure similar to the double incision procedure, removes significant skin in a horizontal pattern. The difference is that the nipple is repositioned in a higher position without being detached. This preserves nipple sensation. (Figure 6)
Vertical or Anchor Incision: If the nipple position is on the underside of the chest, as for a body-builder, a short vertical incision may be used. (Figure 7) An anchor incision, used for female breast reductions is not used to shape a male chest.
Repositioning: When the upper chest skin (skin above the nipple) has sagged significantly, the nipple-areola complex is elevated, improving the overall appearance of the chest.

4- Combination Approach

Indication:

In cases of severe skin laxity combined with excess glandular tissue, a combination of gynecomastia excision, liposuction, and nipple lift may be necessary for optimal results.

Procedure:

This approach may involve multiple techniques tailored to the patient’s unique anatomy and desired outcomes.

Postoperative Care and Recovery:

Compression Garment: Patients are typically advised to wear a compression garment for several weeks to reduce swelling and support the healing process.
Activity Restrictions: Patients should avoid strenuous activities and heavy lifting for 3-4 weeks post-surgery.
Follow-Up Appointments: Regular follow-ups are essential to monitor healing and address any concerns.

Conclusion:

Surgical options for males with hanging nipples after significant weight loss aim to restore a more contoured and masculine chest appearance. The goal is to restore balance for shape, skin and nipple position while concealing scars.