We’re not talking about breakfast pastries here, though we do try to stay away from those too. What we mean when we say we’re not fans of the donut is a procedure called a “donut mastopexy,” or male breast reduction surgery with an incision all the way around the areola. For the guys we treat with man boobs, there are better choices.
The term “donut mastopexy” is shorthand for “circumareolar mastopexy.” This means the surgeon accesses tissue under the skin by making incisions all the way around the areolas.
The term “mastopexy” actually means “breast lift.” When used referring to gynecomastia surgery, it’s usually in the context of a patient who has some measure of lax skin that would benefit from the removal, in addition to excess breast gland and fat. Sometimes, cosmetic surgeons who are inexperienced with other ways to treat patients with enlarged breasts also use the circumareolar technique.
We have yet to find a patient with man boobs who would warrant taking the risks of circumareolar incisions. If a fair amount of redundant skin needs to be removed, then the tension on the eventual sutures is just too great. After healing, scars are often wide, thick and lumpy, as in the case of this man who posted on gynecomastia.org. Any chance of keeping scars narrow requires permanent stitches just below the surface of the skin. The patient can feel these “lasso” sutures after healing.
Another consideration is that although incisions around the areolas do allow access, they mean that blood supply is confined to the tissue directly below the nipple/areola complex. Therefore, effective gland excision is really not possible.
As we mentioned when we advised the gynecomastia.org patient, many cosmetic surgeons with little experience in male breast reduction aren’t aware of how well the skin can tighten once excess gland and fat are removed. We use a special cannula of our own design for liposuction and gentle tissue excision as needed, and to loosen and re-drape the skin. Some patients require just tiny nicks at the side of the chest to allow us to insert the cannula. If more access is needed, we may make an additional small incision at one edge of the areola— never all the way around.
We have seen patients’ skin begin to tighten up right on the operating table! In the months following gynecomastia surgery, further tightening occurs and the areolas usually shrink around 15% in diameter. Many patients are reasonably satisfied with their results when we sit down for a six-month review. Should a guy decide further tightening is needed, we can perform a procedure we created called an “wing mastopexy.” This surgery can eliminate excess skin and elevate areolas if needed, with additional (but minimal) scarring.
Given our specialty in man boob surgery for West Palm Beach area men, and our thirty plus years of experience in the field, we serve as a go-to practice for difficult cases including scar revision. If you visit our image gallery, you’ll see many before and after gynecomastia scar revision photos. We think you’ll agree that we can improve results for many patients, but the best course of action is always to get it right the first time.
When we have the chance to advise guys who have received a recommendation for a donut mastopexy, we strongly suggest they get at least one more opinion from a board certified plastic surgeon who truly specializes in man boobs. And we certainly welcome patients to get in touch with us.
Reach out to Dr. Jacobs today to schedule your consultation!