Trying to Avoid Scars in Gynecomastia Surgery? Sometimes That Gives the Worst Result

No skin laxity, lower areolar border is enough.

For mild cases, I usually prefer no skin excision. If the skin quality is decent, it can often contract well after gland removal and liposuction, so adding more scars is not always worth it.

For moderate cases, for most patients I treat skin laxity with energy-based skin tightening to try to improve contraction and contour. That can help in the right case, but it does have limits and won’t replace proper excision if the skin excess is more significant.

If a moderate case has already been treated and the result is still loose, or the nipple position still looks low, then a circumareolar nipple lift after 6 months can sometimes be used as a secondary procedure for failed cases. This method is nevertheless chosen by some patients as first option rather than as a delayed approach. From our studies around 80% of this grade do not need further skin excision surgery.

For more severe cases, when the nipple is sagging especially in patients after major weight loss, a horizontal scar with free nipple-areola grafting is often the most effective option as in the photos above. I’m definitely seeing more of these patients now, where the main issue is not just gland or fat, but a real excess of chest skin that needs excision to get a good satisfactory chest contour.

These are the most common techniques I use. There are other techniques, but they’re less commonly used and tend to be more case-specific.

Other factors that matter when choosing the incision are preference, keloid risk, smoking, whether the patient is still losing weight, and general health. If someone is still actively losing weight, for example, it may be better to wait until things are more stable before deciding on the final skin excision pattern.

Main point is: the worse the laxity, the bigger the excision usually needs to be. Trying to avoid scars in someone with a lot of loose skin often just leads to an under-corrected chest. Sometimes it is difficult for patients to accept scars hence realistic expectation is important to achieve a satisfactory outcome.

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