Gynecomastia is the most common breast problem in men. Male patients that sustain massive weight loss after gastric bypass or by dieting, often need correction of gynecomastia. The treatment of gynecomastia after massive weight loss is different than that of typical gynecomastia. In particular, these weight loss patients have an excess of redundant skin and nipple-areola complex ptosis.

In the last three years we treated 15 patients with gynecomastia. Six of them had massive weight loss. Two underwent gastric bypass and four lost weight through dieting. All six patients were treated with a combination of tumescent liposuction, direct parenchymal excision and a donut mastopexy-type skin excision. Liposuction was performed to remove the fatty component of the gynecomastia and for mobilization of the inframammary fold. Glandular excision was accomplished through an inferior peri-areolar incision. A small amount of gland was left under the nipple-areola complex to prevent nipple-areola retraction. Redundant skin was excised by de-epithelialization of an appropriate size circumareolar donut. Closed suction drains were placed and the wound was closed with a circumareoral intradermal purse-string suture, deep dermal sutures and a continuous intradermal suture. An elastic compressive garment was worn for 3 weeks to enhance skin retraction.

The follow-up period ranged from two months to three years. We did not observe any complications and all patients were satisfied with a masculine breast contour. The combination of tumescent liposuction, glandular excision, and donut circumareolar skin excision, using a complete circumareolar approach, offers volume reduction and correction of ptosis and skin excess with a cosmetically acceptable well-concealed scar.