This 41-year-old patient came to the Charlotte Gynecomastia Center not because he had excess glandular tissue, but because of something far less common.
After an intense fitness journey that involved losing over 100 pounds, he was left with stretched skin and hanging nipples that distorted his otherwise muscular, well-defined chest. As a fitness trainer and bodybuilder, he had excellent pectoral development and very little body fat, but the skin no longer matched the tight muscle beneath.
The issue wasn’t gynecomastia in the traditional sense. There was no dense breast gland or fatty tissue to remove. Instead, the problem was purely skin-related. The nipple-areolar complexes sat too low, particularly on the outer portion of the chest, which gave the illusion of breast sagging.
His goal was to restore the appearance of a high, tight, masculine chest that matched the rest of his physique.
Identifying the Problem: It Wasn’t Gynecomastia
During his evaluation, it was clear that the underlying muscle tone was excellent. There was no evidence of glandular overgrowth or fatty buildup. Instead, the sagging appearance came from:
- Excess skin from major weight loss: After dropping over 100 pounds, his skin had lost tension in the lower and lateral chest areas.
- Displaced nipple position: The areola had descended, particularly on the outer portion of the pectoral muscle, due to stretched skin.
- Loss of skin elasticity: Despite his muscle mass, the skin failed to recoil upward, creating a mismatch between muscle projection and nipple placement.
The ideal solution would need to preserve the muscle, tighten the skin, and reposition the nipple without sacrificing sensation or introducing visible scarring that could undermine his lean physique.
Designing a Custom Surgical Approach
We developed a highly customized procedure that focused on excess skin removal and nipple relocation. The surgical plan required careful attention to both aesthetics and function.
We wanted the scar to be hidden, the nipple to retain sensation, and the final chest shape to be sharp and athletic, not flat or overcorrected.
Key Steps of the Procedure
- Nipple marking in a standing position: With the patient upright, we identified the ideal placement of the nipple along the lower lateral border of the pectoralis muscle to create symmetry with the upper chest contour.
- Skin patterning for removal: We drew a surgical pattern that would remove the exact amount of stretched skin without creating unnecessary tension or puckering.
- Nipple remained attached: Instead of removing and grafting the nipple, it was kept attached to underlying tissue to preserve blood supply and nerve connections.
- Curved incision placement: A scar was created around the areola, followed by a short vertical line and a curving lateral incision that matched the natural crease under the outer chest muscle.
- Structural anchoring of skin: To create a sharp lateral edge and hide the scar, internal ligaments beneath the skin were sutured to deeper structures. This created a wrap effect along the outer border of the pectoral muscle.
Every aspect of the incision design was guided by his muscular shape, so the scars would fall in the shadows of his chest and underarm, effectively disappearing during day-to-day movement or in gym attire.
One Year Later: Results and Sensation
Now, one year post-op, his results speak to the precision of this approach. His chest is no longer distorted by loose skin or displaced nipples. The chest appears full, lifted, and proportional, and the scar placement is subtle and strategic.
Long-Term Outcomes
- Chest symmetry restored: Both sides now show clean contour lines, with nipples centered over the muscle belly.
- Scars concealed in muscle folds: The lateral chest incision follows the natural shape of his physique and remains hidden even during arm movement.
- Preserved sensation: One year later, the right nipple has partial sensation, while the left retains full sensation.
- No distortion or tethering: The skin lies smoothly over the muscle without dimpling, stretching, or visible surgical distortion.
For patients who are extremely lean and muscular, even slight asymmetries or scarring can be noticeable. In this case, everything was planned to enhance the muscular anatomy.
Final Thoughts
This case is a powerful reminder that chest concerns in men don’t always fall under traditional gynecomastia.
For patients who have lost significant weight or have disproportionate skin versus muscle tone, advanced skin removal and reshaping techniques are essential. Our goal is always to tailor each approach to the individual’s body and goals.
This patient had worked hard for his physique, and he deserved results that reflected that effort. At the Charlotte Gynecomastia Center, we’re committed to restoring not just chest shape, but confidence, precision, and functionality.
Schedule your consultation today to get started!
