Author Topic: Gynecomastia Mastopexy Surgery Forum - Skin Reduction Permanent Suture UK  (Read 5959 times)

Offline DrBermant

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Second Opinion

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, MD
Learn More About Male Mastopexy Chest Lift for Sagging Tissues
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Offline tonytony

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Re: Gynecomastia Mastopexy Surgery Forum - Skin Reduction Permanent Suture UK
« Reply #1 on: February 06, 2013, 06:41:14 AM »
Quote
Second Opinion

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.

newbielink:http://www.plasticsurgery4u.com/procedure_folder/male_breast/gynecomastia_excess_skin.html [nonactive] 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 newbielink:http://www.plasticsurgery4u.com/procedure_folder/male_breast_lift/male_breast_lift_pictures.htm [nonactive]. 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. newbielink:http://www.plasticsurgery4u.com/gynecomastia/standard_video_male_chest.htm [nonactive] are even more critical of how tissues move. We have tools here on newbielink:http://www.abodybeautiful.com/gynecomastia_forum/gynecomastia_surgeon.htm [nonactive]. 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 newbielink:http://www.plasticsurgery4u.com/procedure_folder/male_breast_lift/skin_reduction_chest_lift.htm [nonactive] was necessary. This eliminates the unnatural very obvious unnatural vertical scar.  For smaller problems, I evolved my newbielink:http://www.plasticsurgery4u.com/procedure_folder/male_breast_lift/male_mastopexy_surgery.html [nonactive] that has even smaller scars.  My internal lift is not suitable when the excess skin is a major contributing factor for the deformity.  A newbielink:http://www.plasticsurgery4u.com/procedure_folder/male_breast_lift/male_donut_mastopexy.htm [nonactive] 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 newbielink:http://www.plasticsurgery4u.com/procedure_folder/male_breast_lift/male_large_areola.html [nonactive]. 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 newbielink:http://www.plasticsurgery4u.com/procedure_folder/male_breast/emotion_stress_gynecomastia.htm [nonactive] that most move on with their lives not wanting to be reminded about their problems for long term follow up photos or newbielink:http://www.plasticsurgery4u.com/gynecomastia/male_nipple_exam.html [nonactive]. 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 newbielink:http://www.plasticsurgery4u.com/gynecomastia_gallery/index.html [nonactive] 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 newbielink:http://www.thesurgerystore.com/body_fat-weight_loss/body_fat_analyzer_scales.htm [nonactive] or BMI? Have you reviewed before and after critical documentation of what the surgeon has done?

Hope this helps,

Michael Bermant, MD
Learn More About newbielink:http://www.plasticsurgery4u.com/procedure_folder/male_breast_lift/index.html [nonactive]

Hello,

Thanks for your reply. Yes, the reason I need to have it done this way is because of the weight loss I have had, which has left stretch marks and taken away the elasticity of the skin.

My main question was regarding the toughness of a permanent suture - will I be able to do the normal things such as sleeping on my side, stretching whilst yawning and going to the gym without worrying about my stitches? I suppose they will be quite small and therefore less likely to snap from strain, but it still still a strange thought knowing that I will have them for life. Will they last 10 years? 20 years?

He will be using Gore-Tex.

Offline DrBermant

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Re: Gynecomastia Mastopexy Surgery Forum - Skin Reduction Permanent Suture UK
« Reply #2 on: February 06, 2013, 07:57:11 AM »
Hello,

Thanks for your reply. Yes, the reason I need to have it done this way is because of the weight loss I have had, which has left stretch marks and taken away the elasticity of the skin.

My main question was regarding the toughness of a permanent suture - will I be able to do the normal things such as sleeping on my side, stretching whilst yawning and going to the gym without worrying about my stitches? I suppose they will be quite small and therefore less likely to snap from strain, but it still still a strange thought knowing that I will have them for life. Will they last 10 years? 20 years?

He will be using Gore-Tex.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Did you even take the time to carefully read the answer and review each link? I have already answered that question:

Quote
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.

The nature of non regenerating material is that it does not regenerate. What size gortex will be used, how deep, how well will it be placed, how much tension in the design, will there be trauma to the suture done during placement, how will the know be tied, and so many other factors go into the details of the answer that as I said I preferred avoiding the method when possible. I also made sure there were many extra sutures available before a patient's surgery so I could throw out a suture that had a defect as I was working on it and tying my knots. My choice was to design my surgery not to be dependent on a structural material I knew had an unpredictable long term nature. Otherwise as I already also said, I cautioned my patients the suture is at risk for breaking. That is why I evolved methods to manage the male chest after weight loss in a different fashion when I could.

Check with your surgeon for his / her male chest long term suture risks with their methods. When validating such experience isolate Male Mastopexy from Female Mastopexy as the suture tension factors are totally different for the resultant shapes sculpted.

Did you look at many before after surgery photographs / videos by that surgeon? The Male Chest Donut Mastopexy is not a trivial operation and it is reasonable to see just what a surgeon's skill levels are with this problem before having surgery. How did the examples compare with your body type and degree of loose tissues? Was the documentation done with critical before after methods showing how loose skin was managed?  Check our resource on How to Use Before After Photographs to better understand this issue.

Is the amount of loose skin sufficient for a skin reduction method? How will the loose skin be managed under the arms and around the back? Did you look for examples showing the compromises in the global skin reduction issues? Is there loose skin in the belly region? If so and contemplating such tightening in the future, will the nipples then get pulled down with a subsequent Tummy Tuck as the tension can pull the chest lower.  I have seen such disasters done by other surgeons when patients then came for my help. I preferred to stage After Weight Loss global skin compensation to optimize tissue tension such as you ask about in the design of the donut surgery. Can Tummy Tuck and Chest Lift Be Done Same Surgery?.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Male Mastopexy Chest Lift for Sagging Tissues
Michael Bermant, MD
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Offline tonytony

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Re: Gynecomastia Mastopexy Surgery Forum - Skin Reduction Permanent Suture UK
« Reply #3 on: February 07, 2013, 06:10:50 AM »
Thanks again for your reply. I do agree that this are definitely risks with this approach, but my surgeon comes with one of the most expensive and well known cosmetic surgery groups in London, and the surgeon himself seemed very competent and confident so I will probably go ahead with the sutures. The quality of the procedure and how well he stitches/tightens them will most certainly be a factor, but I trust in his skill.

I have, however asked the surgery if I can talk to one of his previous patients that have undergone this procedure to see how they are getting along with the stitches, or if they have had any problems. Reading through the links you kindly supplied, I noticed the one case about the Australian who ended up with very large areolas after an operation. I believe he then had a reduction surgery and was fitted with a permanent suture to keep them at a good size. Have you heard anything about him since he had them put in, or if he had any problems?

I am fairly sure I will go down the suture route unless I find something that really alarms me. It is a difficult choice because it is not a 100% certain long-term solution, but it does leave very little scarring, whereas other options are most definitely permanent but leave a lot more scarring.

Thanks again for any advice or opinion.

Offline DrBermant

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Re: Gynecomastia Mastopexy Surgery Forum - Skin Reduction Permanent Suture UK
« Reply #4 on: February 08, 2013, 08:17:33 PM »
Thanks again for your reply. I do agree that this are definitely risks with this approach, but my surgeon comes with one of the most expensive and well known cosmetic surgery groups in London, and the surgeon himself seemed very competent and confident so I will probably go ahead with the sutures. The quality of the procedure and how well he stitches/tightens them will most certainly be a factor, but I trust in his skill.

I have, however asked the surgery if I can talk to one of his previous patients that have undergone this procedure to see how they are getting along with the stitches, or if they have had any problems. Reading through the links you kindly supplied, I noticed the one case about the Australian who ended up with very large areolas after an operation. I believe he then had a reduction surgery and was fitted with a permanent suture to keep them at a good size. Have you heard anything about him since he had them put in, or if he had any problems?

I am fairly sure I will go down the suture route unless I find something that really alarms me. It is a difficult choice because it is not a 100% certain long-term solution, but it does leave very little scarring, whereas other options are most definitely permanent but leave a lot more scarring.

Thanks again for any advice or opinion.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

None of the patients I used permanent buried suture  has failed or at least has let me know about a failure. But then I optimized the tissue forces and suture material. I saw several Large Areola Complication patients from other surgeons who had no clue what they were doing on performing this surgery.

The same tissue balancing force problem also happens trying to keep a belly button small. Here suture tissue forces when not managed appropriately lead to a similar disaster, just a different part of  the anatomy. Tummy Tuck Revision for Large Belly Button Complication. The close up belly button views best show the problem. Solution similar, design the surgery based on tissue suture forces. I saw quite a few patients from other surgeons' failed attempts to manage that problem with similar suture techniques. Here are a few of those Patient Experiences for Revision Belly Button.

Being the most expensive surgeon is not necessarily an indicator of skills. I also saw many individuals who complained they also used cost factor (high price) as proof of skill vs the video / photo method. For that factor, I saw complications both ways: inexpensive and high cost gynecomastia surgery.

Revision surgery becomes so much more difficult if the wrong method was done for the wrong problem. A key factor in surgical sculpture skill is best demonstrated by reviewing before and after pictures of that specific artist. That is the responsibility of the person having the surgery to investigate. I saw so many unhappy individuals who asked for my help after having surgery done elsewhere. The primary operation is the best chance of best result.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Revision Gynecomastia and Chest Surgery
Michael Bermant, MD
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