The Skin lift procedure is an innovative procedure performed by Dr Amit Gupta, to accommodate the extra skin in Grades 4a and above. The amount of skin lift depends on the amount of laxity and it may be asymmetrical on both the sides. In some patients it is required on only one side. It may be as less as 1.5 cm to as much as 6 cms

Indications

• The skin lift is performed in patients with Grade 2b, 3, 4a 
• May be asymmetrical 
• May be unilateral 
• Useful in patients with skin sagging, loose spongy skin, severe stretch marks

Procedure

• The marking is done to bring the level of the nipple to a desired level to take away the operated look
• Infiltration is done in the breast as well as superficially in the dermis at the same time with the infiltration canula
• Epidermis depth skin is removed, preserving the dermis 
• Liposuction is done to reduce the fat 
• Flaps are raised to  by preserving at least 1 cm tissue thickness below the “lift flap” 
• At least 1 cm is maintained deep to the areola to allow good projection 
• Continuous 2.0 nylon sutures are made from areola to upper dermis to create lift 
• Ignore dog ears if any at the ends 
• Put 1 suture each at the 2 ends to take care of the dog ears if any
• Closure with 3.0 monocryl continuous sutures 

Note – there might be some mismatch between the two sides with skin lift procedures specially if done unilaterally

Advantages

• Tackles sagging
• Good to get symmetry in unilateral and asymmetric gynecomastia
• Useful in patients with very large glands where the nipple just sags after removal of the gland

Disadvantages

• Longer time to heal
• Scar on upper end of areola
• Sometimes skin gaping can happen. 
• Longer down time