Can this be fixed? Honest opinion please

[decimal]

Dear Doctors,

As evident from my multiple recent posts, I got my gyno surgery (excision and lipo) done on Dec 4. The swelling subsided completely about 2 weeks ago, and as of now I look healed up with no bruising on the surface.

What I am very worried about is the right hand side of my chest. The area below my nipple and towards the center of the chest is dented. As time has progressed, the dent has become only more conspicuous and now has a thick crease/wrinkle running across it. With each passing day, the crease is getting deeper nd deeper. If I press the skin, I can feel the bony structure of my chest a lot more compared to the other side. I asked my doctor about it, and he didnt have a clear answer except that I should give it time. When I asked him if it could be case of excessive fat removal, he did say that liposuction is a "blind procedure" and that it could be a possibility, but given time usually the remaining fat cells are able to fill up such unevenness.

Right now I am utterly depressed. I cant believe that I am saying this but I was actually a lot happier with my pre-op chest. Even though it was bulky, at least it looked natural. What I have now looks disfigured and ugly.

Could you doctors please have a look at the picture, and give me an honest and frank opinion about whether there is absolutely any way to fix this now.  Each passing day, my chest looks frailer and more uneven.

PS: The left side of my chest does not look that bad. There is definitely wrinkling around my nipples when I bring my arms to my side, but it is seems mostly coz of excessive loose skin rather than overagressive liposuction. In the pictures, I have pulled up the skin to show what my chest looks like if the skin were to tone up.

I have tried to take the pictures in the stance that emphasizes the problem the most. Raising my arms or using the camera flash, tends to make problem quite inconspicuous.


Pre op:
http://picasaweb.google.com/postopchest/1MonthPostOp?authkey=Gv1sRgCPeHrNHIr9i-jQE#5424440510503140114

16 days post op:
http://picasaweb.google.com/postopchest/16DaysPostOp?authkey=Gv1sRgCJKoxqPI98_UEg#5417340912555974786

1 month post op:
http://picasaweb.google.com/postopchest/1MonthPostOp?authkey=Gv1sRgCPeHrNHIr9i-jQE#


I hope I did not sound too wordy or confusing. My mind is a mess. What was initially a mild form of embarrasment with my gyne, has now turned to sheer loath for my chest whenever I look at it. Please tell me if a revision surgery could fix this and what would be the earliest time that I could get one. Or is it that I am doomed with a distorted chest  

[decimal]

On asking my doctor, he said he had aimed for close to 100% removal of the gland and about 80% removal of fat.

Is that a normal goal for liposuction? I was mortified for a second, because 80% sounded a LOT to me. But then again, he has done several liposuction procedures before and is an expert, while I am just a lay man.

[Dr. Elliot Jacobs]

At one month, it is much too early to tell.  You are in the "firm stage" of healing -- a combination of a small amount of residual swelling and early scar tissue.

While it may eventually be necessary to do some revision work, would strongly advise waiting for at least 4-6 months for everything to soften up and settle down.  Then you can make an assessment about the overall results.  Would then go back to your surgeon and discuss the results with him and see if he can reasonably do anything to improve things.  You might also solicit opinions from several other experienced gyne surgeons as well.

Dr Jacobs

[DrBermant]

Dear Doctors,

As evident from my multiple recent posts, I got my gyno surgery (excision and lipo) done on Dec 4. The swelling subsided completely about 2 weeks ago, and as of now I look healed up with no bruising on the surface.

What I am very worried about is the right hand side of my chest. The area below my nipple and towards the center of the chest is dented. As time has progressed, the dent has become only more conspicuous and now has a thick crease/wrinkle running across it. With each passing day, the crease is getting deeper nd deeper. If I press the skin, I can feel the bony structure of my chest a lot more compared to the other side. I asked my doctor about it, and he didnt have a clear answer except that I should give it time. When I asked him if it could be case of excessive fat removal, he did say that liposuction is a "blind procedure" and that it could be a possibility, but given time usually the remaining fat cells are able to fill up such unevenness.

Right now I am utterly depressed. I cant believe that I am saying this but I was actually a lot happier with my pre-op chest. Even though it was bulky, at least it looked natural. What I have now looks disfigured and ugly.

Could you doctors please have a look at the picture, and give me an honest and frank opinion about whether there is absolutely any way to fix this now.  Each passing day, my chest looks frailer and more uneven.

PS: The left side of my chest does not look that bad. There is definitely wrinkling around my nipples when I bring my arms to my side, but it is seems mostly coz of excessive loose skin rather than overagressive liposuction. In the pictures, I have pulled up the skin to show what my chest looks like if the skin were to tone up.

I have tried to take the pictures in the stance that emphasizes the problem the most. Raising my arms or using the camera flash, tends to make problem quite inconspicuous.


Pre op:
http://picasaweb.google.com/postopchest/1MonthPostOp?authkey=Gv1sRgCPeHrNHIr9i-jQE#5424440510503140114

16 days post op:
http://picasaweb.google.com/postopchest/16DaysPostOp?authkey=Gv1sRgCJKoxqPI98_UEg#5417340912555974786

1 month post op:
http://picasaweb.google.com/postopchest/1MonthPostOp?authkey=Gv1sRgCPeHrNHIr9i-jQE#


I hope I did not sound too wordy or confusing. My mind is a mess. What was initially a mild form of embarrasment with my gyne, has now turned to sheer loath for my chest whenever I look at it. Please tell me if a revision surgery could fix this and what would be the earliest time that I could get one. Or is it that I am doomed with a distorted chest  

1 month can be very early after surgery with some techniques. 

Posting Standard After Gynecomastia Pictures can help other better understand your concerns.  After Gynecomastia Surgery Video can show issues such as animation defects to a greater degree.

How Tissues Evolve After Gynecomastia Surgery depend on many factors. Firm tissues after surgery can be residual gland, but also can just be healing tissues or scars.  Different surgical techniques injure tissues to different degrees.  The body typically needs to heal before considering revision surgery. Rushing into secondary surgery can be a mistake unless there are complications that need to be addressed or the next surgery is component of a staged procedure.  Time to tissues softening can vary depending on the original problem, what was done, after surgery care, Scar Care, After Surgery Compression Garments, and many other factors. Options depend on the problem to be treated. Time can range from 6 months to a year but can vary depending on many issues best explored with your doctor.

Revision surgery options depend on many factors and are based on compromise. It is easier to take away than put back. That is why selection of a surgeon is so critical.  Options are best explored during a consultation with a surgeon who has demonstrated such skills.  Choice of revision surgeon can be even more critical as this is often more difficult sculpture. 

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia Surgery

[decimal]

Thank for the responses Doctors.

Just wondering that if certain area feels conspicuously bony (i can feel my ribs too well at the dented site, almost like there is nothing between the skin and the bone, although I am sure that is not the literal case) compared to the surrounding areas, right from the first day after surgery, is it not a sure-shot sign of excessive fat removal?

I had asked my doctor why a skin reduction wasnt performed even though I had been 30 pounds heavier about 7 years earlier, and wouldnt my skin;s elasticity have suffered as a consequence. I was told that he had thought about it, and had examined by skin for "indentures"( or "infractions" - not sure what was the exact technical term that he used). Since he found none on my chest skin, he felt that my skin's elasticity was still intact and it should contract just fine over six months to an year. Is that right? I am confused since I got the impression on this forum that once a person has been overweight his skin's elasticity deteriorates permanently?


Lastly, could you doctors please comment on the numbers - removal of 80% fat during liposuction? Does that translate into too much fat being removed, coz it quite sounds like it? Or is it that percentages are quite meaningless ? I would really appreciate an expert's remark on this.