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Blog. Terrified of Tethering?

What is tethering and why does it strike fear into the hearts of men planning gynecomastia surgery?

Tethering is a possible complication for some guys after male breast reduction. Our patients almost never have this problem, but it does occur with less experienced plastic surgeons. We answer questions about the condition in online forums often—from guys who wonder what to do about tethering and even from those who are worried about it before it happens!

The Basics of Tethering After Gynecomastia Surgery

Tethering occurs when scar tissue—which is inevitable with male breast reduction—anchors the underside of the dermis (skin) to the chest muscle. With areas of the skin literally stuck to structures underneath, surface results can look creased, dimpled and/or lumpy. Depending on the extent of the tethering, the smooth contours the patient was anticipating can be marred a little or a lot.

How to Avoid Tethering

In the spirit of “an ounce of prevention is worth a pound of cure,” and “the best defense is a good offense,” the right way to handle tethering is to avoid it in the first place. This means prospective gynecomastia surgery patients need to seek 1) a board certified plastic surgeon with an excellent reputation who is also 2) a gynecomastia specialist. This second point is very important because there are fewer plastic surgeons with extensive experience with man boobs than most guys think. Male breast reduction is essentially a specialty within a specialty—not just any surgeon or even plastic surgeon will do.

Here in our practice, gynecomastia surgery is performed by excising gland tissue and suctioning excess fat away gently with instruments we created specifically for this purpose. We leave a thin, uniform layer of fat between skin and muscle underneath to create the coveted masculine contours AND to prevent tethering.

What NOT to Do About It

Patients who do end up with a tethering problem after healing often look around for solutions and come up with ideas that may seem logical, but aren’t really options. Kenalog injections, which can work to reduce lumpy scar tissue that isn’t stuck, can cause fat atrophy and skin thinning—the opposite of what’s needed. Scar tissue that’s tethered can’t simply be cut, because the raw ends find each other and reattach.

Some guys ask about massage. In our view, massage may help an occasional patient to a limited extent, but generally we aren’t in favor of post surgical massage. There’s a risk that it can cause additional swelling, especially in the early stages of healing. We have noted that sometimes massage can stretch scar tissue, but not remove it.

If You Do Experience Tethering

We do work with many men who come in for gynecomastia revision surgery, and tethering is an issue we address for some. The way we approach the problem is to cut the scar tissue and introduce a “spacer” so it will not re-adhere. We use fat flaps for this purpose—small “tongues” of fatty tissue next to the problem area. The fat tissue is loosened, then repositioned between skin and muscle to prevent them from becoming stuck again. Because we use flaps, not grafts, the fatty tissue survives and does its job.

If you’re a guy with post-surgical contours you find disappointing, consider contacting us. We work with gynecomastia revision patients from across the country and around the globe—guys who are often willing to travel to get a better result the second time around when surgery is even trickier than at first. If you’re not near South Florida, we can conduct a consultation using a combination of mail, email and phone, then you can decide what’s best for you.


Dr. Elliot William Jacobs is a board-certified aesthetic plastic surgeon who specializes in FTM top surgery, gynecomastia surgery, revision gynecomastia surgery and male breast reduction. He is a native of New York and has over 40 years of experience in his field. Dr. Jacobs is a highly respected and sought-after surgeon who is known for his skill, experience, and compassion. Whether you are interested in gynecomastia for the first time, or are looking to correct a gynecomastia you aren’t happy with, Dr. Jacobs can deliver amazing results.


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