Why Did My Gynecomastia Reduction Surgery Not Work?

Q: Dr. Eppley, I had gynecomastia reduction surgery one month ago. While I have fairly large boobs to begin with I am disappointed with what I see so far. I see very little difference. I thought all my chest fat was going to be removed and the saggy skin tightened. I expected a flat chest but that is not what I have. What do I do now?

A: While I have no idea what you looked like before and now after surgery, your description leads me to give some general comments. As was likely discussed during your initial consultation, gynecomastias that have more significant mounds and hanging skin are difficult problems. In such cases the problem is the amount of extra skin that you have and not so much the fat which has likely been significantly reduced from your surgery. (you can not remove all fat from any body site anywhere so this is not a realistic concept) In these larger gynecomastias the choices are to place large scars across your chest to adequately remove the extra skin in a single operation or to limit the scars to around the nipples and see how much improvement can be obtained being restricted by this approach. Large scars that extend out from the nipples are not acceptable in men in my opinion and a choice you would regret later no matter how flat your chest became from that approach. Because of keeping the scars acceptable and to just around the nipples, the chances were likely that a second surgery would be needed for further skin reduction and the best result. Your gynecomastia problem is undoubtably a challenging one and one of the most difficult to treat without undue scarring. 

At this point, it is too early to yet judge the final result from your initial gynecomastia surgery. It takes up to three months for all swelling to go away and the tissues to maximally contract to see the final result. Whether it will signficantly improve or not is unknown but you must give it that amount of time. I would suggest that you go back to your surgeon three months after the procedure for further follow-up and discussion.

Dr. Barry Eppley

Indianapolis, Indiana