Animation Deformity

[spooon]

Hello Doctors

I am 9 months post surgery. The result looks pretty good when I am relaxed. However, upon any kind of pec muscle contraction which can include anything from showing off in the mirror to simply reaching out with my hand, I develop an unsightly crater on one side. My surgeon has offered to perform a fat graft for free but he has only ever performed 5 of these in his career since he has a such a high satisfaction rate. I guess i was one of the unlucky ones. He is considered the best surgeon in London but it seems to me that he lacks revision experience. Is there really a unique skill needed to be able to pull off a fat graft / fat flap procedure? It's really got me down. I can try to post a photo in the relaxed state and also one in the flexed position if there is a doctor here willing to take a look?

Thank you

[Dr. Schuster]

Some surgeons prefer fat flaps when available, others fat grafts. Surgeons who do a lot of fat grafting for other surgeries probably prefer that. If your surgeon has good success with fat grafting elsewhere it should work well in your chest, provided that the scar tissue is not too tight.

[spooon]

Thank you. I will check how experienced he is with fat grafts elsewhere in the body. Do you think there is any harm in injecting a filler to see what kind of look might be achievable? I appreciate it's not a long term solution.

[Dr. Schuster]

Non fat fillers can probably be used but it might take a lot of product which means it could get pricey for a result that might only last a year.

[Miguel Delgado MD]

Dear Spoon,
In my experience, I have had much better success with fat flaps if possible.  It is very predictable because it is living tissue, therefore, it does not absorb. This is a one-time surgery. Fat grafting is dependent on the vascularity of the crater deformity and the amount of scar tissue that is present. Therefore, this may require 2-3 fat injection sessions.  Your doctor has evaluated you chest and feels that fat injections are the best option. Your doctor has a good reputation and has very good outcomes with fat injections.  Good luck 

[spooon]

Non fat fillers can probably be used but it might take a lot of product which means it could get pricey for a result that might only last a year.

Thank you i might try that. I think it will be good for my sanity to achieve an improvement even if temporary that does not involve having general anesthetic /recovery/scarring all over again. Do you know if hyaluronic acid would work? I read it is very safe.

[spooon]

Dear Spoon,
In my experience, I have had much better success with fat flaps if possible.  It is very predictable because it is living tissue, therefore, it does not absorb. This is a one-time surgery. Fat grafting is dependent on the vascularity of the crater deformity and the amount of scar tissue that is present. Therefore, this may require 2-3 fat injection sessions.  Your doctor has evaluated you chest and feels that fat injections are the best option. Your doctor has a good reputation and has very good outcomes with fat injections.  Good luck

Thank you. It does seem based on searching the web that that fat flaps is the better option. Question - for the skilled gynecomastia surgeon, does performing a fat flap present a unique challenge? Should i be 'shopping' for a surgeon that has performed this before? I will speak to him again and get his take on fat flaps.

[Dr. Elliot Jacobs]

It has been my experience that fat flaps are the preferred treatment for contour or crater deformities, providing there is enough surrounding fat to do the job.  This is a one time procedure.  Fat grafting often requires multiple procedures.

Dr Jacobs