title: Pseudogynecomastia after massive weight loss: detectability of technique, patient satisfaction, and classification.
abstract: BACKGROUND
  An increasing number of male patients are presenting for treatment of male chest deformity after massive weight loss. The authors prefer to preserve the nipple-areola complex on a dermoglandular pedicle. They sought to identify detectability of technique, assess patient satisfaction, and outline a treatment algorithm for this population.
  
  
  METHODS
  Ten male massive weight loss patients underwent chest-contouring procedures over a period of 6 years and were surveyed to identify satisfaction with reconstruction. Preoperative photographs were used to devise a classification system. Twenty-seven medical professionals evaluated and rated digital photographs of the patients.
  
  
  RESULTS
  Eight patients had pedicled reconstructions and two had free-nipple grafts. Mean age was 42.9 +/- 9.5 years, mean pre-weight loss body mass index was 54.1 +/- 10.6, post-weight loss body mass index was 29.4 +/- 4.5, and mean change in body mass index was 24.8 +/- 9.7. All patients would have surgery again, nine would recommend it to a friend, six would go shirtless in public, nine reported no loss of nipple sensation, and three reported dysesthesias of the nipple-areola complex. Medical professionals reproducibly associated poor wound healing with free-nipple grafting and rated poorly positioned nipple-areola complexes with low aesthetic scores. Medical professional scores for chest contour and nipple-areola complex aesthetics did not correlate with technique and were lower than scores provided by the patients.
  
  
  CONCLUSIONS
  Patient satisfaction for treatment of the male chest deformity after massive weight loss is high. In carefully selected patients, preservation of the nipple-areola complex on a dermoglandular pedicle can aid in achieving an optimal aesthetic result.
authors.affiliation: Pittsburgh, Pa. From the Division of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Life After Weight Loss Center.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Gusenoff
authors.forename: Devin
authors.initials: D
authors.lastname: Coon
authors.forename: J Peter
authors.initials: JP
authors.lastname: Rubin
mesh_terms: D000328:Adult; D003625:Data Collection; D015390:Gastric Bypass; D006177:Gynecomastia / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D016462:Mammaplasty; D008875:Middle Aged; D009558:Nipples / Q000601:surgery; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications; D012042:Registries; D035441:Thoracic Wall / Q000601:surgery; D015431:Weight Loss