Skin is a dynamic tissue. It can stretch and shrink. Skin stretches due to factors like excessive fat deposition underneath as in obesity, large amount of fat and glandular tissue as in male breasts or Gynecomastia, due to excessive muscles development as in body builders and due to overall tissue stretching as in pregnancy. Skin can stretch greatly draping large volumes of underlying mammary glands and fat deposits but, it may not shrink back completely if it has lost its tone due to excessive stretching. It is only up to a limit beyond that a stretched skin will not shrink back completely on its own after male breast surgery. Surgeon may have to perform an additional surgery to remove the excessive, toneless residual skin. The important question is, when this surgery should be performed? On this issue there is a wide variance in opinion of surgeons based upon their own experiences.
In our experience, the skin in small and moderate sized male breasts and often in large male breasts shrinks back almost completely. In such cases skin does not sag once the healing is complete. Besides, some degree of skin shrinkage continues even up to a year after surgery. We will be able to tell you after examination how much likely skin shrinkage you should expect post-surgery. We feel removing excess skin at the time of primary male breasts surgery is ill advised. In our practice we let the skin shrink to full extent naturally and deal with residual skin after six months or a year. It is our experience that only in very rare instances residual skin removal surgery is required. Your surgeon may also give you some advice on how to promote shrinkage of residual skin through non-surgical means. The situation is different in conditions where there is complete chest tissue sagging after massive weight loss after bariatric surgery or through lifestyle management. A distinction must be made between true Gynecomastia and sagging of folds of skin all over the body including chest after bariatric surgery. Treatment is different in the two situations which you can discuss with your cosmetic surgeon during your consultation.
Incidence of Gyno / Gynecomastia is very high. Almost 25-30% of boys suffer from this condition. It can be a very psychologically disturbing condition as boys are supposed to have flat, muscular chest. Breasts are not at all appropriate on boys’ chest.