September 17, 2026 | Body, Male Procedures
A patient came in on a Friday morning. He had been almost two ninety back in 2017. He was down about a hundred pounds, going to the gym two or three times a week, and the chest had not changed. He told me it had been a thorn in his side since he was about 11 or 12 years old.
These are the answers I gave him, taken from the consultation itself and reproduced here with identifiers removed.
“Can you just liposuction it?”
“The problem is that we have a considerable amount of sagging. If I just did lipo, obviously you remove the volume, but it would still be sagging. So I don’t think you want that.”
Emptying the envelope does not tighten the envelope. For a chest with firm skin and mostly fatty fullness, liposuction with a skin tightening device can work well. For a chest that has been stretched for twenty years, it will not.
“So I will have a scar?”
“Unfortunately, the trade off is the only way to do it is really with a scar. So I would have to put a scar right underneath the fold. And it would go to about here.”
“What happens to the nipple?”
“With that, I would be able to remove the tissue and the fat and the breast tissue, and then we would use the nipple. I would take it off completely, and then put it back on like a graft. Because I don’t think even with the tightening lasers, I don’t think it’s going to spring back. Especially this side.”
That sounds more dramatic than it is. On a chest that has stretched a long way, it is the reliable way to get the nipple in the right position and the right size on a flat chest.
“Why are you also talking about my sides?”
“That’s why I recommend doing the lipo on the sides, because otherwise it’s going to look like you have a side breast. Because you won’t have anything here.”
The chest does not end at the edge of the pectoral muscle. Treating the lateral chest is what makes the result read as a chest rather than as a repair.
“How flat will it actually be?”
“It’ll be completely flat.”
“Can I combine it with a tummy tuck?”
He was a candidate for both, which is common after a hundred pound loss.
“So you are a good candidate for a tummy tuck. The incision goes here. It will remove some of the fat on the mons and it’ll also lift it up. And the scar is going to go to where the fold ends. With that, we’ll be able to remove pretty much all the skin from here down. And then I’ll use this skin, and that’s the one we’re going to pull down. Look at your muscles. If there’s any separation, we’ll put them back together. But you’ll have a nice, tight, flat abdomen.”
On doing both at once:
“Yes. Because really the chest is not going to add any recovery. So you have that advantage of just that one recovery, and you’re done. Number one, it’s safe because we’re still under six hours, which is most important. And then it becomes a little less expensive, because the first hour of surgery is the most expensive.”
“If we did it together, the surgery would be about four and a half to five hours, general anesthesia. It is in and out. You can go home the same day.”
“What is recovery like?”
“Recovery wise, you’re looking at about two weeks, mostly from the tummy, to get back to normal activity, driving, things like that. And then six weeks where you can go back to exercise, lifting, pretty much back to normal without any restrictions.”
“We would have drains, both in the chest, one on each side. Those are going to come out pretty quick, four to seven days. Then the tummy, those can take a little longer. It could be seven to fourteen days.”
“You’ll have your garments. I do recommend doing lymphatic massages. We have a tech here. And it helps get the swelling down a lot quicker, especially in the areas of liposuction. It helps avoid the fibrosis and bumpiness.”
“I live alone. Is that a problem?”
Not a problem, but tell me in advance.
“So then I would keep you overnight, because we can’t send you home like that. And then in the morning, we do have a service that can take you back home. My nurse will visit you the day after you stay overnight, to help you shower and how to take care of the drains and go over all the instructions again. You can extend those visits, or there’s also a third party we work with a lot that can keep coming in to check on you, and even help you with food and transportation.”
He had three dogs. “You would probably want to board your dogs for at least a while.”
“Why did I wait so long?”
He answered that himself: “I’ll go to the gym, but then I get really discouraged. I get to a certain point, like, oh, this is good. And then it’s not going to tighten.”
It is not going to tighten. That is not a failure of effort.
Why patients trust me with this
I am a double board-certified plastic surgeon, certified by both the American Board of Plastic Surgery and the American Board of Surgery, a Mayo Clinic fellowship alum, and I teach plastic surgery as a Clinical Associate Professor at Texas Tech University Health Sciences Center. Male chest surgery is a judgment operation: how much tissue to take, whether the skin will retract, where the scar sits, whether the nipple stays or moves. Those calls are what separate a flat chest from a dented one.
For men coming off a large weight loss, the chest is usually one piece of a larger plan. My body contouring after major weight loss page covers the rest.
Ready to Talk?
If your chest has bothered you since you were a teenager, you have already waited long enough. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments.
#StayBeautiful
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
