Hello Dr Bermant,
I hope you don't mind me contacting you out of the blue like this, I realise you must get a lot of emails with questions but I have seen posts of yours on online forums which shows an admirable willingness to take questions from people. On that basis, I was wondering if I could get a quick opinion from you on something?
My name is -, I am 26 and I live in London, England. In four weeks time I am due to go for gynecomastia surgery that will require some skin removal to prevent sagging, as recommend by my surgeon, Dr.-.
For minimal scarring, he also said he would use the Mastoplexy method, which will remove the 'donut' of skin, which will then be covered by pulling skin over. He will then be using Permanent gore-tex sutures underneath to keep it all together, and I believe this also prevents the areola from becoming stretched.
I have asked him the following questions and he seems confident that there will be no problem, but nonetheless I feel a bit daunted by having under-skin stitches for life and was wondering if you had any knowledge on this.
The main concern (other than the very small chance of infection) is the strength of these stitches. Will I be walking on eggshells the rest of my life, or will they be able to tough out every day activities (after a good period of healing and being careful of course).
Would I be able to exercise with jogging and weights (chest muscles) a few months later or are the stitches liable to snap. If someone were to push me in the chest, would they break or shift easily?
I understand these things are down to the skill of the surgeon, and some other variable factors but assuming he is skilled and there are no complications, would permanent sutures be tough enough to last through the years and the stress?
I really would appreciate anything you have to say on this.
All the best, and thank you.
This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon. Sorry, I no longer offer email or private message responses, nor second opinions. I do try to share my knowledge here in this forum. Excess Skin of the Male Chest with Gynecomastia
comes in various degrees. Management depends on many different factors. I preferred techniques avoiding the skin reduction whenever possible, but this depended on the amount of loose skin involved. Judging the amount of excess skin and effectiveness of the surgery requires critical documentation. That is why I evolved my Standard Pictures for Evaluating Extra Skin on the Male Chest
. If a doctor is only showing results of patients standing upright, then there little to go by to validate the problems worked on, their judgement, or skills. Standard Videos Male Chest
are even more critical of how tissues move. We have tools here on How to Pick Your Gynecomastia Surgeon
. The difference here, is that the problem is a loose skin issue and the pictures evaluating the technique should demonstrate just how effective that method is in real life. Seeing photos of someone standing upright just tells part of the story. Unless you can see what the tissues look like with the individual bending over or with arms up overhead, you are not really seeing what the body looks like in real life.
For some patients, my small incision skin reduction chest lift
was necessary. This eliminates the unnatural very obvious unnatural vertical scar. For smaller problems, I evolved my Internal Lift Male Mastopexy Surgery
that has even smaller scars. My internal lift is not suitable when the excess skin is a major contributing factor for the deformity. A Male Donut Mastopexy
when pushed too far will leave a star burst deformity that detracts from the result. That is why picking your surgeon carefully can be so important.
Choice of suture for the donut mastopexy is critical. Wrong material and wrinkling or worse Large Nipple Areola Complication from Bad Gynecomastia Surgery
. It is a function of not just the suture, but the design of the surgery based on the problem, and where the suture is placed, size of suture, and many other factors. Again why seeing examples of the surgeon's work in motion critical to judge just what is being offered. Long term results are hard to get. There is so much Emotion Living with Gynecomastia
that most move on with their lives not wanting to be reminded about their problems for long term follow up photos or Male Nipple Measurement Exam
. When I had to do a skin reduction, each patient was cautioned that suture breakage was a risk. But again, that is why I evolved methods not to need to do skin reduction surgery yet still have good results and less long term risks potentially depending on non-regenerating materials like suture.
So questions best managed by the operating doctor based on their knowledge, plans, and experience. When skin reduction done when not needed and ending up with a disaster like I showed, that is really sad. But then why are not surgeons showing the degree of loose skin problem and success of tightening with better documentation like I evolved?
Why not post a complete Standard Set of photos and compare them to the various degrees of non skin reduction surgery success I had with my techniques using our extensive Before After Gynecomastia Gallery
A good surgeon should be able to manage a large male breast reduction without the skin reduction unless there were significant weight loss lost skin elasticity. How much weight was lost? What was the change in the Body Fat Analysis
or BMI? Have you reviewed before and after critical documentation of what the surgeon has done?
Hope this helps,
Michael Bermant, MDLearn More About Male Mastopexy Chest Lift for Sagging Tissues