Enhancing Masculine Features After Massive Weight Loss
Aesth Plast Surg
Enhancing Masculine Features After Massive Weight Loss
Dennis Hurwitz 0 1 2
0 University of Pittsburgh Medical Center , 3109 Forbes Avenue, Pittsburgh, PA 15213 , USA
1 & Dennis Hurwitz
2 Presented in part at the 2014 meetings of the American Association of Plastic Surgeons in Miami, Florida; Northeastern Society of Plastic Surgeons in Providence, Rhode Island; and the Ohio Valley Society of Plastic Surgeons at the Greenbrier Resort , West Virginia , USA
Background Whereas body contouring surgery after massive weight loss in women emphasizes sculptured adipose and broader lower torso, little attention has been devoted to accentuating the male physique. Objective To determine if boomerang excision pattern correction of gynecomastia with J torsoplasty combined with an abdominoplasty with oblique excisions directly over bulging flanks provide effective and safe optimizing of muscle visibility and upper torso dominance. Methods A description of comprehensive body contouring through an abdominoplasty and a series of obliquely oriented ellipses of the male torso is followed by review of 19 consecutive patients. Results Seventeen patients were performed in a single stage. Nine of the last ten cases included J torsoplasty and oblique excision extensions over the flanks. Of the 17 patients responding to a ten-question survey, 15 were satisfied with chest improvement. One of the first eight patients with a transverse lower body lift was satisfied with the flank bulges. All of the last eight cases with direct oblique flank excisions were satisfied with their lower body. Five patients (26 %), having a total of 74 operative procedures, had significant complications of chest hematoma, persistent hip and buttock seromas, superior NAC
Male body contouring correction; Body contouring surgery; Boomerang correction of gynecomastia; Upper body lift; Lower body lift; Gynecomastia; Abdominoplasty; Liposuction
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edge necrosis, and distal necrosis of the fleur de lis
abdominoplasty. One boomerang correction underwent
minor revisions. One transverse lower body lift underwent
major revision. No complications occurred in the last ten
patients, having oblique flank excisions instead of
transverse lower body lifts.
Conclusion Comprehensive excisional body contouring
surgery of a central high tension abdominoplasty with a
series of obliquely oriented ellipses throughout the torso
appears to provide low risk improved body contour for the
muscular male.
Level of Evidence IV This journal requires that authors
assign a level of evidence to each article. For a full
description of these Evidence-Based Medicine ratings,
please refer to the Table of Contents or the online
Instructions to Authors www.springer.com/00266.
Introduction
After massive weight loss (MWL), men seek body
contouring surgery for the removal of excess skin and fat
followed by tightening and suspension of residual lax
tissues. Men generally have correction of
pseudogynecomastia and an abdominoplasty extending into a lower body
lift [
1
].
Since many men are obsessed with muscle show and
upper torso dominance and are considering plastic surgery
to achieve those goals [
2
], plastic surgeons should be
prepared to accentuate those features. This is a preliminary
report of total body lift (TBL) [
3
] surgery that seeks that
transformation through abdominoplasty and a crisscross
pattern of elliptical excisions across the torso (Fig. 1) [
4
].
By removal of most horizontal and vertical excess skin and
fat, uniformly tight skin across the torso leaves upper body
dominance, muscular show, and two sets of long zigzag
scars (Fig. 2). This comprehensive surgery is presented and
then followed by a review of 19 consecutive patients
(Table 1).
The indication for this male TBL is sagging
pseudogynecomastia with moderate to severe skin laxity of the
abdomen and flanks 1 year after stable MWL. The ideal
patient is muscular, healthy, and frustrated that rigorous
bodybuilding fails to reveal visible results. He desires a
harmonious muscularity throughout the torso with the
upper dominating the lower. Less sinewy and older men,
seeking more muscular show, are also considered. Lengthy
operations and scars throughout their torso must be
accepted. All patients understand that the boomerang
pattern originated with this author and that combining that
operation with an abdominoplasty and posterior excisions
is an exceptionally lengthy surgery. The operations are
staged for BMI over 34, excessive skin resections, chronic
illness, or patient concern. Patients agreed to be reported
anonymously with consent obtained for photograph
presentation.
Case 1 (Table 1, patient 1) has generalized loose skin
and residual adipose bulges of pseudogynecomastia, and
lower body bulging abdominal pannus, mons pubis, and
love handles (Fig. 3). This 27-year-old male lost 60
pounds, and regained 20 when frustrated by lack of
muscular show. Through a 12-week HCG/500 calorie a day
diet [ (...truncated)