Currently, men make up a minority of patients presenting for body contouring surgery after weight loss. However, their numbers are increasing and they have several different body concerns that women. One of these is that of the chest area. The skin sag and the presence of excess fat under the nipple creates a relatively new type of problem. Some call this chest problem gynecomastia but that is inaccurate. It is really pseudogynecomastia as it has more skin and less actual fat.
Most male chest deformities after weight loss require dealing with the extra skin. Some patients may need liposuction only but this is not common in my experience. When a male patient is motivated to undergo chest reconstruction, they almost always have a significant problem. It usually requires removal of skin and then what to do with the the sagging and often stretched out nipple. The skin part is relatively easy. The overhanging skin (that which sags below the lower chest crease) is horizontally removed with the goal of making the chest flat and keeping the final scar low enough so that it hopefully lies in the natural skin crease at the lower end of the chest muscle.
The more difficult choice is how to manage the sagging nipple. Choosing a new location is based on standard measurements but how to get there is another. The nipple can be removed and replaced like a skin graft or the nipple can be moved while attached to some underlying breast tissue. (similar to how it is done in a female breast reduction) Both methods are reasonable but they have slightly different outcomes. Free nipple grafting gives one the flexibility to place it anywhere on the chest but the nipple will not have sensation and make look a little artificial and stuck-on. (plus there is no guarantee it will survive and it may lose some color after it is healed. ) Pedicled nipple grafts are harder to perform and are more limited in where they can be placed. But they usually look more natural and have better color. In some cases, the amount of sagging chest skin dictates which nipple technique can be used. But in others, it is a matter of the patient’s choice and their level of concern about the look of the nipple. In many cases, like in severe gynecomastia, the nipple-areolar transposition technique is best with inframammary fold excision.
For male extreme weight loss patients, the chest deformity is right up there in concern just behind the abdominal and waistline areas. Men are most interested in how their chest looks in clothes and want a relatively flat appearance in shirts.
Dr. Barry Eppley