Real Patient Question: Incision Placement for Gynecomastia Surgery

We field a huge list of “what, when, where and why” questions from our gynecomastia patients and from people online at gynecomastia.org. One of the frequent “where” questions relates to incision placement. Naturally, guys worry about where their eventual scars will be located and how noticeable they may be.

The Very Best Case

Fortunately, our patients most often fall into the “best case” category, meaning that tiny nicks are made at the side of the chest. These incisions are usually no more than about 1/8” inch long. Through these little nicks, our specialized instruments enable us to suction away any excess fat, perform light gland removal and re-drape the skin to lie flat.

For most of our patients, the resulting small scars may look a little reddish or darker than the rest of the skin for several weeks or a few months. They eventually fade to near invisibility. Take a look at our gallery of before and after gynecomastia pictures to see what we mean.

The Next Best Thing

Patients with dense, hard breast gland in the center of the breasts may need additional small incisions around the edge of the areola. We take great care to position the incisions to allow us to access the tissue and remove it—rotating fat flaps into the spot if there’s any chance of a crater—while ensuring the scars will look like the natural edge of the areola when healed. We have several examples of typical peri-areolar scars in our gallery, you can find them here.

More Pronounced Scars

There are a few discussions of “bad scarring” in the forums on gynecomastia.org. They sometimes refer to horizontal incision lines at the base of the breasts (or other longer incisions); indeed, these kinds of scars are much larger and more noticeable than the small scars most gynecomastia patients can expect.

There are two ways guys can end up with scars like these. It can happen when a patient works with a very inexperienced doctor, such as a general surgeon who only occasionally treats patients with man boobs. Fortunately, we hear of fewer and fewer of these outcomes as guys learn more about choosing a gynecomastia surgeon.

Longer incisions that leave additional scars are often needed, however, for overweight guys. And sometimes we work with unlucky ones who are not necessarily obese but have oversized breasts anyway. In these cases, the breasts may be large enough to have stretched the skin beyond the point where it can bounce back on its own. There are several options for these patients, in terms of surgery timing as well as incisions, and we carefully walk guys through their choices. You can read an in-depth discussion of gynecomastia and overweight guys here.

At the heart of our conversations with overweight guys is the tradeoff of extra scars for a flatter chest. Some patients decide to forego surgery to avoid scarring, but most feel that looking better in clothing and feeling better about their bodies is worth going ahead.

If you visit our before and after gynecomastia photos, take a look at patient #61 to get a sense of what larger scars can be like. This man’s horizontal scars under the breasts, in the area we call the “inframammary fold,” will fade to look much less prominent with time. But they won’t disappear altogether. This patient gladly accepted the tradeoff—what do you think? Would you?

If you’d like assistance with this decision or with any other aspect of your case, send us an email. We have helped thousands of guys with man boobs in our three plus decades of plastic surgery and we’d be proud to welcome you to our practice.