الفهرس 
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Abstract
Obesity has become a national and worldwide epidemic, classified as overweight or obesity. Obesity is measured by means of the body mass index. And the distribution of fat can assessed practicaly by measurement of the waist circumference, waist to hip ratio and skin fold thickness.
There are numerous comorbidities associated with obesity. Morbid obesity is defined as a body mass index equal to or greater than 40 wheremortility rate among the morbidly obese patients are 2.5 to 12 fold higher than those of normal weight individuals.
Deit, exercise, pharmacotherapy, behavioral therapy, lifestyle modification and bariatric surgery can used for treatment of obesity. Bariatric surgery should considred in adult patients with BMI greater than or equal to 35. Bariatric surgery reduce obesity related complication and long term morbidity and mortality.
Bariatric surgery isthe most reliable way to achieve significant weight loss in overweight and obese populations. Surgical procedures to reduce excess body weight have evolved and are now considered safe especially when performed by experienced surgeons in a center of experience. Bariatric surgery not only causes weight loss but has a significant impact on comorbidities and the overall mortality of obesity. The indications for, and populations benefited by, bariatric surgery continue to expand.
Bariatric surgical procedures can be classified into three categories: malabsorptive, producing weight loss by interfering with caloric digestion and absorption; restrictive, producing weight loss by limiting caloric intake; and mixed, producing weight loss through both mechanisms.
Massive weight loss can produce a severe aesthetic deformities of the male breasts including skin excess, ptosis, low inframammary fold and lateral rolls.
Gynecomastia following massive weight loss can be classified in only two categories based on the required correction, gynecomastia type 1 characterized by mild skin redundancy or breast ptosis that can be corrected by concentric circumareolar excision of the excess skin, gynecomastia type 2 characterized by major skin redundancy and breast ptosis that necessitates excision of chest wall skin with shifting of the nipple position for correction.
The ideal time to perform body contouring procedures is when the weight is stable which is typically 12 to 18 months after weight reduction surgery to reduce postoperative complications.
The ideal method of gynecomastia correction must provide a technical means of removing the excess breast tissue without compromising the blood and nerve supplies to the nipple-areola complex, at the same time it should also provide a method of recontouring the breast mound and handling the problem of skin excess without leaving unsightly or long scars.
The most popular procedures used for management of gynecomastia after massive body weight loss are mastectomy through a horizontal approach with NAC grafting, horizontal approach With inferior de-epithelialized dermo-fascial pedicle,wise pattern excision technique and extended technique with J excision.