Gynecomastia after massive weight loss: Reshaping with intercostal perforator flaps

Gynecomastia is defined as the development of breast tissue in men; it is normal during puberty, but the mammary glands typically atrophy after a short time [1]. The number of bariatric surgery procedures has increased consistently over the past decade [2, 3]. Although this procedure may solve the problem of excess weight and many of its associated comorbidities, the patient is left with excess skin and soft tissue, often leading to referral to plastic surgery [4]. At our institution, the anterior intercostal artery perforator flap is considered for correcting small defects following female breast conservative surgery in the medial quadrants, whereas the lateral intercostal artery perforator flap is preferably used for the outer quadrants [5]; they are also used to restore the shape of female breast after massive weight loss [4]. Kwei [6] used intercostal artery perforator (ICAP) flap as autologous augmentation after massive weight loss. Reshaping of the male chest following massive weight loss is challenging because of severe tissue ptosis that often renders standard surgical techniques inadequate to restore a normal shape. The authors applied the role of ICAP after massive weight loss and present their experience with the intercostal artery perforator flap for correction of severe ptosis of male chest.