Gynecomastia surgery in Korea: 3-month results for Simon Grade 2B with chest sagging
Patient Registration Info
| Age | Weight | Height | BMI |
|---|---|---|---|
|
20s |
79kg |
170cm |
28 |
Surgical site
Surgical site : Gynecomastia | Grade 2-B
Can Excess Skin Remain After Surgery for Large, Sagging Gynecomastia?
When determining the appropriate surgical approach for gynecomastia,
it is important to evaluate not only the size of the chest
but also the degree of skin sagging.
In cases such as Simon Grade 2B or 3,
where sagging is also present, the surgical plan
and postoperative care should take into account
the skin and wrinkles that may remain after removing
the glandular tissue and fat.
Some patients seeking treatment for gynecomastia
are concerned not only about the size of the chest
projecting forward but also about its sagging appearance.
When the chest is already sagging, patients may worry
that a large amount of excess skin will remain after surgery
or that folds may develop along the lower chest.
For this reason, diagnosing gynecomastia involves evaluating
not only the amount of glandular tissue and fat
but also the degree of chest enlargement
and the extent of skin sagging.
One of the classification systems used
as a reference is the Simon classification.
Simon Grades 2B and 3 involve chest enlargement
accompanied by skin sagging.
Therefore, it is important to discuss the expected skin changes
and postoperative management in sufficient detail
before determining the appropriate treatment approach.
[Simon Classification for Gynecomastia – Lesarts Plastic Surgery]
The Simon classification categorizes gynecomastia
by evaluating both the degree of male breast enlargement
and the extent of skin sagging.
Unlike stages with little to no sagging,
Simon Grade 2B requires consideration
of not only chest size but also the remaining skin.
As the condition progresses to Grade 3,
both breast enlargement and skin sagging may become more pronounced,
making it difficult to plan surgery based solely
on removing glandular tissue and fat.
Therefore, for Simon Grade 2B or 3 gynecomastia,
it is important to anticipate how the skin may settle after surgery
and provide appropriate postoperative management accordingly.
[Preoperative Chest Projection and Skin Sagging Before Gynecomastia Surgery]
This patient was in his 20s and had experienced
symptoms of gynecomastia since adolescence.
Although he had tried exercise and weight management,
he did not see satisfactory changes in the size
or shape of his chest.
More recently, he became increasingly concerned
as the areolas appeared larger and more projected.
He was also concerned about the firm, lump-like tissue
he could feel inside the chest.
[Patient Information]
Age: 20s
Height / Weight: 170 cm / 79 kg
Gynecomastia Diagnosis: Mixed-type gynecomastia
(glandular tissue + fat), Simon Grade 2B
Skin Elasticity: Low
[Simon Grade 2B Gynecomastia: Surgical Planning Considering Skin Sagging]
Before surgery, the chest was visibly enlarged overall,
with significant skin sagging that created
a deep fold along the lower chest.
On palpation, firm lump-like tissue could be felt
on both sides, and ultrasound examination also confirmed
enlarged glandular tissue in these areas.
Based on the external appearance, the condition was assessed
as true gynecomastia corresponding to Simon Grade 2B.
However, because the Simon classification is based
on external appearance, the degree of enlargement
and sagging was significant enough that Grade 3
could also be considered depending on the assessment.
[Why a Breast Lift Was Not Performed from the Beginning]
In cases with significant sagging, a breast lift
may be considered to address the remaining excess skin.
However, the patient was still young, in his 20s,
and it was also important to consider that a lift involving
skin excision would leave a relatively long scar.
Therefore, rather than performing extensive skin excision
from the beginning, the initial plan was to remove
the glandular tissue and reduce the overall chest volume
through liposuction, then observe how the skin recovered.
If significant sagging remained afterward,
the changes in skin elasticity and chest contour
would be evaluated before deciding whether
additional treatment or surgery was necessary.
In other words, rather than attempting to correct
all of the sagging in a single procedure,
a staged approach was chosen based on the patient’s age,
concerns about scarring, and expected postoperative skin recovery.
[Changes in Chest Size and Skin Sagging from the Front 3 Months After Gynecomastia Surgery]
Let’s compare the front view before surgery
and 3 months after surgery.
Before surgery, the chest had significant volume,
creating a visibly heavy appearance from the front,
along with downward sagging and a deep lower chest fold.
After surgery, the overall chest size was reduced,
and the previously heavy, downward-projecting shape
appeared noticeably flatter.
The deep fold that had formed along the lower chest
also appeared less pronounced than before surgery.
[Changes in Chest Projection and Sagging from the Side 3 Months After Gynecomastia Surgery]
From the side view, the changes in chest projection
and the skin along the lower chest are more noticeable.
Before surgery, the chest projected significantly forward,
with the lower chest sagging deeply and forming a pronounced fold.
At 3 months after surgery, the forward chest volume
had decreased significantly, while the lower chest line
that had previously sagged and folded appeared much smoother.
[Changes in Chest Volume and Lower Chest Contour from the Oblique View 3 Months After Gynecomastia Surgery]
Because the patient had relatively poor skin elasticity,
how the remaining skin settled after surgery
was an important part of the recovery process.
During recovery, taping was used to help the sagging skin
adapt to the new chest contour.
With postoperative care aimed at helping the skin
settle into a higher position, the overall chest contour
appeared more naturally defined than before surgery.
The nipples and areolas, which had previously appeared lower,
also showed a relative upward shift in position.
[Changes in T-Shirt Fit from the Side 3 Months After Gynecomastia Surgery with Skin Sagging]
[Changes in Chest Contour Under a T-Shirt 3 Months After Simon Grade 2B Gynecomastia Surgery]
When wearing a T-shirt, the change in the chest
that had concerned the patient since adolescence
is even easier to see.
Before surgery, the enlarged chest and projected areolar area
were clearly visible even through a thin T-shirt.
At 3 months after surgery, the front of the chest
appeared noticeably flatter.
Even when wearing more fitted clothing, the chest shape
was no longer emphasized as it had been before,
creating a more natural upper-body contour.
The patient was also satisfied that the psychological burden
and discomfort he had experienced when wearing clothes
had been reduced.
[How Should the Remaining Skin Fold on the Left Side Be Evaluated?]
Not all of the sagging had resolved equally
within 3 months after surgery.
Some skin folds still remained on the left chest,
where the sagging had been particularly severe before surgery.
Compared with the opposite side,
some asymmetry was still noticeable.
However, at 3 months after surgery, the skin
was still adapting to the new chest contour.
Because the remaining folds may gradually improve over time,
the decision was made to continue monitoring
the recovery process.
Rather than immediately adding a breast lift,
there is also the possibility that developing the pectoral muscles
through chest-strengthening exercises may help support
the remaining skin and create a more balanced chest contour.
This was explained to the patient, along with the importance
of continued body and physique management.
This patient had experienced gynecomastia since adolescence
and was concerned not only about chest size
and areolar projection but also about the sagging shape
of the chest.
Examination confirmed mixed-type gynecomastia
with both glandular tissue and fat on both sides.
Skin elasticity was also reduced,
and the condition was classified as Simon Grade 2B.
Based on the degree of sagging alone,
a breast lift could have been considered.
However, considering the patient’s age
and the relatively long scar that would remain
after skin excision, the initial approach was
to reduce the chest volume through gland removal
and liposuction and then observe how the skin recovered.
At 3 months after surgery, the previously heavy,
forward-projecting chest appeared flatter,
and the deep folds along the lower chest
had also become less pronounced.
Despite the patient’s reduced skin elasticity,
postoperative taping was used during recovery.
The nipples and areolas appeared to settle
in a relatively higher position, while the chest contour
under a T-shirt appeared more natural than before surgery.
However, some folds still remained on the left side,
where the preoperative sagging had been more severe,
so further recovery is currently being monitored.
For gynecomastia with skin sagging, such as Simon Grade 2B or 3,
treatment planning should not focus solely on how much
glandular tissue and fat can be removed.
It is also important to evaluate how much excess skin
may remain after surgery, whether skin excision
is necessary from the beginning, or whether chest volume
can first be reduced and the skin response monitored afterward.
If you are considering gynecomastia surgery because of
chest enlargement along with lower chest sagging or deep folds,
a detailed examination and consultation can help determine
your current Simon grade and skin elasticity.
Based on these findings, the appropriate surgical approach
and postoperative management plan can be discussed.
Simon Grade 2B Gynecomastia FAQ
Q1. What is Simon Grade 2B gynecomastia?
Simon Grade 2B gynecomastia involves breast enlargement
accompanied by skin sagging.
Surgical planning should consider not only the removal
of glandular tissue and fat but also the skin
that may remain after surgery.
Q2. Does Simon Grade 2B gynecomastia always require a breast lift?
No. A breast lift is not always necessary.
Factors such as age, skin elasticity, degree of sagging,
and concerns about a longer scar should be considered.
In some cases, gynecomastia surgery may be performed first,
followed by observation of how the skin changes during recovery.
Q3. Can sagging skin improve after gynecomastia surgery?
The degree of improvement varies depending
on factors such as skin elasticity and age.
After the chest volume is reduced, the skin may adapt
to the new chest shape, allowing some sagging
and wrinkles to gradually improve.
Q4. Why is taping used after gynecomastia surgery?
For patients with chest sagging, taping may be used
as part of postoperative care to help the skin
settle into the new chest contour.
Q5. Will skin folds remaining 3 months after surgery stay permanently?
At 3 months, the patient is still in the recovery process.
Remaining skin folds may continue to improve over time,
and further treatment can be considered later
depending on how the recovery progresses.
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