At the Charlotte Gynecomastia Center, we often work with men who have experienced massive weight loss and are left with significant chest skin laxity and persistent gynecomastia.
This case involves a 63-year-old male patient who had undergone gastric sleeve surgery and lost 150 pounds.
While the weight loss dramatically improved his overall health and body composition, it left behind stretched, hanging chest skin and excess breast tissue that did not resolve on its own.
The Patient’s Background
This patient stood 6 feet tall and weighed 211 pounds at the time of his surgery. His chest still had a feminine appearance, with loose, sagging skin and enlarged glandular tissue.
These changes were common after a large weight loss, especially in older patients, where skin elasticity is reduced. The physical appearance was not only a cosmetic concern but also created issues with skin irritation and discomfort.
He came to us seeking a solution that would help him match his chest to the rest of his now-leaner body.
Surgical Approach
In cases like this, standard gynecomastia techniques such as liposuction and gland removal are not enough. The significant skin redundancy required a more advanced surgical plan to create a flatter, firmer chest contour and restore a masculine shape.
We performed the surgery under general anesthesia and focused on three primary areas:
- Excision of excess breast tissue and skin: We removed the stretched glandular tissue and loose skin from the chest to eliminate the overhang and projection.
- Removal of underarm skin folds: Skin extending into the axillary (underarm) region was also excised to prevent bunching and improve the contour from the front to the sides.
- Nipple-areolar reconstruction: The nipples were resized and repositioned using a free nipple graft technique, which allowed us to place them in a natural position on the chest without the risk of stretching or drooping over time.
The incisions were placed carefully to minimize their visibility over time. The main scar runs in the crease beneath the pectoral muscle, with a second incision hidden in the underarm area. These placement decisions help maintain a natural appearance even with the extent of tissue removal required.
One Year After Surgery
At his one-year follow-up, the results were stable and well-defined. His chest now has a significantly flatter and more masculine contour. The nipple grafts have healed well and are positioned in an anatomically appropriate location. The scars are maturing and blend in with the natural folds of the body.
His before and after photos show a dramatic difference not only from the front, but also in the oblique and side views. The hanging skin that once gave his chest a sagging, deflated look is now gone. In its place is a chest that reflects the hard work he put into his weight loss.
Key Aspects of This Case
Several surgical decisions were critical in achieving this patient’s long-term chest transformation.
- Massive weight loss: The patient had lost 150 pounds after a gastric sleeve procedure, which resulted in significant chest laxity.
- Comprehensive skin excision: Both central chest and underarm skin were removed to create a smooth, continuous contour.
- Nipple grafting: The nipples were removed and grafted into a higher, more masculine position as part of the reconstruction.
- Hidden incisions: The scar was placed under the chest muscle fold and in the axilla for optimal concealment.
- Long-term results: Photos taken one year post-op demonstrate the stability and effectiveness of the result.
These combined techniques allowed us to reshape the chest in a way that honored the patient’s weight loss progress and gave him a more proportionate, comfortable upper body.
Final Thoughts
This case is a reminder that gynecomastia surgery is not one-size-fits-all. For men who have undergone significant weight loss, a more advanced surgical approach is often required to properly reshape the chest.
By combining skin excision, gland removal, and nipple reconstruction, we were able to deliver a result that helped this patient move forward with greater confidence and physical comfort.
If you’ve lost a significant amount of weight and are still struggling with the appearance of your chest, know that there are solutions that go beyond standard treatments. We are here to help you take the final step in your transformation.
Schedule your Charlotte gynecomastia consultation today to get started.
