Gynecomastia Reduction Revision

Q: Dr. Eppley, I am seeking gynecomastia reduction revision surgery. had a perfect chest, and put on some weight and thought gynecomastia reduction surgery would be the answer for puffy nipples and getting it more defined. Well the surgery went wrong and I ended up with a nipple indent, scarring, hepatoma and a crater deformity. I then went to another doctor who does revision gynecomastia reductions who said no to pectoral implants but could fix the crater and make it look good. But he ended up over doing liposuction leaving me with less tissue, a caved in look and puffy nipple on the left side which looks still like I have gynecomastia.

The right side is more natural and fuller but left side just doesn’t match it. These doctors were supposedly the best and I am left deformed. I wondering if you looked at my pics and get your opinion. I find the left side the worst with the puffy nipple and more fat missing as this is the side I did’t have the hematoma.

Was wondering if you were able to make my chest more defined again and both sides even looking. thanks

A: Thank you for your inquiry and sending all of your pictures. I am not quite sure how you started out with a relatively small gynecomastia problem and ended up where you are now after multiple surgeries. But that is irrelevant now as all that matters is where you can go from here. I think your gynecomastic revision surgery options depends on how much restoration you want and how much effort you want to put into it. This means the following:

1) With your complicated gynecomastia reduction/liposuction history it would be perfectly understandable that you would want to do the least amount of further surgery that has the lowest risk possible. In that case I would only treat the left side with either fat transfer or a dermal-fat graft. Fat injections have the lowest risk as the worst case scenario is that it doesn’t work well. I don’t know if you really need to put on weight as even in thinner males enough fat can be harvested from the inner thighs to do a small area like the left nipple/lower chest. This would produce the least aesthetic improvement with the only goal being to make the left side look closer to that of the right.

On the opposite end of the treatment spectrum are pectoral implants. Both sides of the chest are really deflated with loose skin. This loose tissue exacerbates any soft tissue deficiency between the two sides. Pectoral implants would expand both sides of the chest and would offer the best chest improvement. Whether some additional work needs done on the nipples at the same time remains to be determined. But with the option for best overall chest improvement comes this ‘bigger’ surgery with its own attendant risks. At this point with your surgical history, this concept make be too much to consider even if it offers the best aesthetic improvement.

Dr. Barry Eppley

Indianapolis, Indiana