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BACKGROUND:After excess skin and fat is removed, a traditional body lift advances skin and suspends ptotic breasts, mons pubis and buttocks. For women, the lift includes sculpting their adiposity. While some excess fat may need to be removed, muscular men should also have a deliberate effort to achieve tight skin closure that reveals superficial muscular bulk. For skin to be tightly bound to muscle, the excess needs to be removed both horizontally and vertically. A Fleur de Lis abdominoplasty is an example in the lower torso. Similarly, the boomerang correction of gynecomastia has been offered for the chest. To that operation we have added an abdominoplasty with oblique excisions over the flanks. Our aim is to present total body lift surgery that effectively and safely tightens skin for well-developed muscular males. METHODS: By office chart review, 23 patients received boomerang pattern correction of gynecomastia since 2002, with more than one-year follow up. The boomerang pattern consists of opposing obliquely oriented elliptical excisions joining over the nipple and extending transversely to complete the upper body lift (UBL). In the last seven patients, a J torsoplasty extension replaced the transverse UBL. Indirect undermining and the opposing force of a simultaneous abdominoplasty were utilized to obliterate the inframammary fold. In 6 of the 7 patients, the abdominoplasty was extended by oblique excisions over bulging flanks and a picture-frame monsplasty. 5 of these 7 patients were performed in a single stage.
RESULTS:Satisfactory improvement was observed in all 23 boomerang cases. One patient was displeased with distorted nipples after revision surgery. Scar maturation in the chest is lengthy, taking more than a year to flatten and fade. Complications were limited to minor suture line dehiscence(1) and edgewise skin necrosis(1). Secondary surgery consisted of nipple revisions and one liposuction of the inferior breast. There were no deaths. Two major complications were chest wall hematomas requiring surgical drainage. In the subset of seven comprehensive cases with J Torsoplasty and oblique flank excisions, tight skin and muscular contours were evident with primary healing and no revisions. CONCLUSION:As in the female, male body contouring should consider the entire torso. Bodybuilding males have pride in the appearance of their muscular development. Accordingly, sagging skin, gynecomastia and ptotic Mons pubis as occurs after weight loss frustrates the fitness-inclined. Optimal body contouring for men drapes skin tightly over well-developed torso muscles. In selected patients, comprehensive body contouring surgery consists of a boomerang correction of gynecomastia and J torsoplasty with an abdominoplasty has proven to be a practical means to achieve aesthetic goals. Gender-specific body lift surgery that goes beyond the treatment of gynecomastia best serves the muscular male after massive weight loss.