Male Chest Grade 4 Gynecomastia: Double Mastectomy and Areolar Grafts

Posted by Dr. Dadvand February 3, 2025

Gynecomastia surgery is one of the most rewarding procedures I perform at my Beverly Hills practice. Today, I want to share an inside look at a recent case of severe Grade 4 gynecomastia—where excess breast tissue, loose skin, and low nipple position all needed to be addressed for optimal results.

How Weight Loss Affected My Patient’s Chest Appearance

This particular patient had lost 80 pounds, which significantly affected his chest. While his weight loss was a great achievement, it left him with excess skin, enlarged areolas, and a low nipple position. Traditional gynecomastia surgery—just liposuction and tissue excision—wasn’t going to be enough. The extra skin had to be removed, and the nipple position had to be corrected to achieve a natural, masculine chest contour.

One key factor in planning this surgery was his breast footprint—the point where the chest tissue starts projecting from the body. Some men have a high breast footprint, some in the middle, and some, like this patient, have a lower footprint. This determines where I place the incisions and how I shape the final result.

My Surgical Plan

For this patient, I designed an approach that included:

• Mastectomy to remove the excess breast tissue
• Skin tightening to eliminate sagging skin
• Free nipple grafts to reposition the nipples in an aesthetically appropriate location
• Liposuction to refine the contour, especially around the armpit area

My markings included a key incision pattern that allowed for maximal skin removal while maintaining a natural chest shape. I also planned to reduce his areolas significantly—since smaller, well-positioned areolas contribute to a masculine chest appearance.

Let Me Walk You Through the Procedure

Once in the operating room, I began by making precise incisions and removing the excess tissue. The difference was immediate—his chest went from sagging to tight and sculpted. I also performed liposuction on the right side to create a more symmetrical contour.

The most technical part of the procedure was the free nipple grafts. Because the nipples had to be repositioned much higher, I had to detach them and graft them onto the newly contoured chest. To ensure their survival, I carefully thinned them out, allowing new blood supply to reach the grafts. This is a critical step—if the nipple tissue is too thick, it won’t receive enough blood flow and could fail to heal properly.

Achieving the Desired Gynecomastia Results

By the end of the surgery, the transformation was dramatic. His chest was flat, firm, and balanced. The nipple position had been lifted by about five inches, aligning beautifully with his pectoral muscles. The incisions extended in a curved pattern to eliminate any excess skin, preventing sagging or dog ears at the edges.

While the incisions will take time to heal, they tend to fade well over time. More importantly, this procedure gave my patient a completely new chest contour—one that matches his weight loss and fitness efforts.

Why This Surgery Matters

For men suffering from severe gynecomastia, there’s no alternative to surgery. No amount of exercise or weight loss can correct the excess skin and tissue. This procedure isn’t just about aesthetics; it’s about restoring confidence, comfort, and the ability to wear clothes without self-consciousness.

If you’re struggling with gynecomastia, know that solutions exist. I’m Dr. Babak Dadvand, a double board-certified plastic surgeon, here to help you achieve the chest contour you’ve worked hard for. If you have questions about gynecomastia surgery, feel free to reach out and schedule a consultation with me in LA!