Refinements in Male Chest Lifting

Goals/Purpose: Gynecomastia is a common condition affecting many adolescent and adult males. In mild to moderate cases, we have found power-assisted liposuction and the pull-through technique very effective. However, in more severe cases, excess skin, malpositioned nipple-areola complexes, and poor chest shape necessitate skin removal and repositioning of the nipple-areola complexes. In these cases, a common approach involves free nipple grafting and a horizontal scar after removal of the excess skin. However, free nipple grafting may result in loss of sensation, pigment, and erectile function of the nipples. Over the past few years, our approach has consisted of transposition of the nipple-areola complex using an inferior pedicle and the skin excision pattern has evolved to result in a curvilinear scar along the inferior and lateral border of the chest. In this study, we review our early experience and outcomes using this approach for severe cases of gynecomastia.

Methods/Technique: A crescentic skin excision pattern is marked so the resulting curvilinear scar will be along the inferior and lateral border of the chest. SAFELipo liposuction is used to reduce chest volume including the lateral chest, as necessary. An inferior pedicle is deepithelialized and the nipple-areola complex is transposed to lay at the inferolateral aspect of the pectoralis major muscle. The superior skin is elevated in the subglandular plane and advanced over the pedicle while the inferior skin is advanced superiorly and medially. A layered closure including progressive tension sutures is performed and drains are not used. The skin at the new position of the nipple-areola complex is excised and the nipple-areola complex is inset. The technique is shown using an operative video.

Results/Complications: From July 2019 to November 2021, eight consecutive male patients with severe gynecomastia underwent surgery. The mean age was 34 years (range, 20 to 55 years) and the mean BMI was 31 kg/m² (range, 24 to 35 kg/m²). The mean operative time was 113 minutes (range, 91 to 161 minutes), the mean excised tissue weight was 160 g (range, 35 to 333 g) and the mean liposuction volume was 293 ml (range, 0 to 1250 ml). Three cases (37.5 percent) were performed in combination with other body contouring procedures. The average length of follow-up was 148 days (range, 24 to 416 days). One patient (12.5 percent) had scar revision. There were no complications. All patients reported that nipple-areola complex sensitivity was preserved. The aesthetic outcomes were good, and patients reported being satisfied with the results.

Conclusion: s: This approach for severe cases of gynecomastia has proved safe and effective in our early experience. A pedicled nipple-areola complex has the benefit of maintaining sensation while the curvilinear scar along the inferior and lateral border of the chest creates a more attractive and masculine appearing male chest.