A Unified Approach to the Correction of Male Torso Deformities After Massive Weight Loss: A 443-Patient Consecutive Series

Although numerous techniques have been described, standardized approaches for comprehensive male torso reconstruction remain limited. This study presents a unified approach integrating circumferential planning, chest reshaping, and abdominal contouring. A retrospective review was performed of 443 consecutive male MWL patients treated between 2018 and 2024. All patients underwent a standardized protocol combining posterior body lift, chest reduction/mastopexy, and either standard or fleur-de-lis (FDL) abdominoplasty. Preoperative planning incorporated Pascal’s Rule of 16 for circumferential marking, while chest management utilized a pedicle-length–based decision pathway. Closure techniques and postoperative management, including compression therapy and lymphatic massage, were standardized. Outcomes were assessed using BODY-Q patient-reported outcome measures and prospectively recorded complications. Mean BMI was 29.6 (range, 22.4–34.3), and mean follow-up was 7 months. Mean tissue resection weights were 1006 g for posterior body lift and 2148 g for abdominoplasty, with approximately 240 g removed per breast. Complications included 13 (2.9%) breast hematomas, 16 (3.6%) abdominal hematomas, 8 (1.8%) partial nipple–areola complex necroses, 1 T-junction necrosis requiring grafting, 4 (0.9%) hypertrophic scars, and 52 (11.7%) seromas. Revision surgery was required in five patients. Significant improvements were observed across all BODY-Q domains, with satisfaction scores increasing from the low 40s preoperatively to above 80 postoperatively (p < 0.001). A unified approach to male MWL torso reconstruction provides safe, reproducible, and reliable outcomes. Standardized planning, objective chest management criteria, consistent closure techniques, and structured postoperative care contribute to low complication rates and high patient satisfaction. Level of Evidence: IV