Gynecomastia Correction in Individuals with Below Average Skin Elasticity

Jay M Pensler*
Department of Plastic Surgery, Northwestern University Feinberg School of Medicine, USA

*Corresponding author: Jay M Pensler, Department of Plastic Surgery, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive Suite, USA

Published: 09 Mar, 2018
Cite this article as: Pensler JM. Gynecomastia Correction in Individuals with Below Average Skin Elasticity. Clin Surg. 2018; 3: 1929.


Gynecomastia or enlarged breasts in men is a problem attracting increased attention [1-14]. Gynecomastia has been our primary clinical interest for over twenty years. We have fortunately been able to treat a range of individuals presenting with this deformity. We have on the basis of our experience continuously refined our surgical approach. Combining the physical resection of the breast tissue involved in each case of gynecomastia with redistribution of the thoraco-abdominal skin envelope we have reduced the need for skin resection in patients with below average skin elasticity.
Between January of 1997 and December of 2017, we have treated two thousand three hundred and seventeen patients with gynecomastia. Age range of the patients is ten years old to seventynine years of age. Patients are categorized based on the amount of glandular (breast tissue) present and the amount of adipose tissue present. A ratio is determined pre-operatively and recorded for each patient. In addition, the patients’ skin elasticity is recorded as above average, average or below average. Based on the aforementioned metrics combined with the individual’s Body Mass Index (BMI) and medical history, a definitive treatment plan is established. Patients with decreased skin elasticity remain some of the most challenging patients and formed the basis of this report. Over the aforementioned time period, we have treated six hundred eighty-eight patients with below average skin elasticity. Virtually all patients require a combination of liposuction and glandular tissue excision to remove the involved tissue. The remaining component of surgery, (50%) deals with optimizing the final result. Patients with poor skin elasticity in addition to resection and liposuction require a specialized treatment strategy to optimize the final result. Skin resection leaves obvious scarring which is irreversible. In an effort to minimize its requirement for skin resection we have designed a protocol to widely undermine the skin to facilitate an increased area where skin elasticity is allowed to interact with the area of resection to optimize the result. Undermining occurs inferiorly into the mid abdominal area, typically 6cm above the umbilicus in most severe cases. This approach has reduced the need for skin resection to twenty-nine patients in our series.
The following patient is illustrative of the technique involved:
Thirty-five year old Male presents with approximately seventy percent glandular tissue and thirty percent fat (Figure 1). His skin elasticity is below average. In addition to resection of glandular tissue and liposuction of the fat, wide undermining was performed into the abdomen to approximately half way between the inframammary crease and the umbilicus to facilitate redistribution of the fat of the skin and the soft tissue. A compression vest was applied postoperative to facilitate healing. The post-operative views illustrate the resection of the large volume of tissue and an improved redistribution of the skin (Figure 2). Skin redistribution allows much better contour of the chest wall which is appreciated from the lateral and anterior views (Figure 2) in patients with reduced skin elasticity. The increased degree of undermining facilitates recruitment of a larger skin area to absorb the laxity present in these patients. Clearly this is not applicable for massive weight loss patients with tremendous skin laxity and very poor elasticity. In cases with massive weight loss, a total body lift is the only option. We have found that in the majority of Gynecomastia cases with below average skin elasticity, wide undermining and repositioning of the thoraco-abdominal skin envelope can be effective in optimizing the final result and avoiding the requirement for skin resection and the inevitable

Figure 1

Another alt text

Figure 1
Male, 35 years of age with Gynecomastia and below average skin elasticity pre operatively.

Figure 2

Another alt text

Figure 2
Male, 35 years of age post operatively. Note the redistribution of the skin envelope.


  1. Pensler JM, Delgado Jr MA, Yost JM.  Plastic Surgery for Gynecomastia. d 2016.
  2. Devalia HL, Layer GT. Current concepts in gynaecomastia. Surgeon. 2009;7(2):114-9.
  3. Nydick M, Bustos J, Dale JH Jr, Rawson RW. Gynecomastia in adolescent boys. JAMA. 1961;178:449-54.
  4. Webster GV. Gynecomastia in the Navy. Mil Surg. 1944;95:375-9.
  5. Williams GM. Gynecomastia. N Engl J Med. 1993;329(3):209.
  6. Eckman A, Dobs A. Drug-induced gynecomastia. Expert Opin Drug Saf. 2008;7(6):691-702.
  7. Morrone N, Morrone Junior N, Braz AG, Maia JA. Gynecomastia: a rare adverse effect of isoniazid. J Bras Pneumol. 2008;34(11):978-81.
  8. Parker LN, Gray DR, Lai MK, Levin ER. Treatment of gynecomastia with tamoxifen: a double-blind crossover study. Metabolism. 1986;35(8):705-8.
  9. Parker S. A male breast lesion. Surgical-tutor.org.uk. 2003.
  10. Pensler JM, Silverman BL, Sanghavi J, Goolsby C, Speck G, Brizio-Molteni L, et al. Estrogen and progesterone receptors in gynecomastia. Plast Reconstr Surg. 2000;106(5):1011-3.
  11. Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia. Plast Reconstr Surg. 1973;51(1):48-52.
  12. Yost M. Demystifying Gynecomastia: Men with Breasts. Mens Health. 2006;1:1-122.
  13. Singer-Granick CJ, Granick MS. Gynecomastia what the surgeon needs to know. Eplasty. 2009;9:e6.
  14. Athwal RK, Donovan R, Mirza M. Clinical examination allied to ultrasonography in the assessment of new onset gynaecomastia: an observational study. J Clin Diagn Res. 2014;8(6):NC09-11.