Crater Deformity -- Can this be Corrected?

[bluephiman72]

I am four weeks post-op and am overall pleased with the surgery results, but am concerned regarding possible crater deformity. I've attached before and after photos. As you can see from the first two pics, I had bad gyno. Combination of gyno and being overweight.









I had the surgery about 5 months after the preop pics were taken. I lost some weight before my surgery by getting back in the gym, which helped in my overall sculpture.





If my chest looked like this with movement then I would be totally satisfied, but as you can see from the other pics, when I flex there is some serious depressions and "stuckage". I have some scare tissue and hoping this is the problem and "releases" but from all the discussion I've read on this site and my own research, I'm skeptical if that's going to happen. Plus, there's hardly any scar tissue on the right. No lump or hardness at all, but nipple still contracts up and in when I flex. Doc was more aggressive on the left and I can definitely feel the scar tissue, but most of it has resolved beautifully over the past couple weeks.  

RELAXED, THEN FLEXED:






RELAXED, THEN FLEXED:






FLEXED:








Can any doctors tell me whether this is likely to improve, or am I already looking at revision surgery via fat grafting or fat flap. I know it takes months for things to resolve, but your experience can tell you right away whether there's a problem here and the likelihood this will improve.

My girlfriend was concerned about me emotionally and asking quite often whether I was ok or regreted the surgery. I told her that I had a deformity before the surgery, and apparently one after....if I had to live with one, I prefer this one. But would still prefer to fix this if possible. Thanks for your input.

[Litlriki]

Your results are still early, and a lot was done to remove the tissue, which will require progression of healing including resolution of swelling and maturation of scar with skin contraction.  These things take time.  I have my patients massage the chest during this time to prevent tethering of the skin due to scar tissue, but you should speak to your surgeon about that.  Seeing issues with flexion is not uncommon, especially early on.

Patience.

Rick Silverman

[Dr. Elliot Jacobs]

You are much to early in the healing process to make any decisions on the success of the operation.  Even if something was terribly wrong (which it isn't), no surgeon would touch you until many months of healing had passed.

Suggest you relax, allow Mother Nature to heal, and touch base with your surgeon from time to time to assess your concerns.

Dr Jacobs

[DrPensler]

you are still very early but you appear to look good at rest which is encouraging.

[bluephiman72]

@Dr. Silverman: Thank you for your comments. "Tethering" was the term I was searching for and it better describes what's going on. I know these things take time, but the procedure can take such an emotional toll on you. I didn't appreciate that aspect of post-surgery recovery. I will definitely give it more time and hopefully it improves satisfactorily.

@Dr. Jacobs: Thanks for the advice. I'm a very easy going guy and have a generally positive attitude. I will do my best to not look in the mirror every day to measure incremental changes that aren't obvious on a daily basis. I wouldn't want another procedure right now. As you've preached on this site, secondary procedures are always tougher and I want to give this at least 6 months before I come to any final conclusions. Guess I just needed someone else to say it's going to be ok.

@Dr. Pensler: I totally agree with you with the look at rest. It still blows my mind how much my chest has changed from pre to post. I told my doc I was concerned regarding the depressions when flexing, but don't regret the procedure. I like him and think overall he did a great job. From the beginning, he said this was not an exact science and a surgeon has to use his best judgment on how much to remove or not remove. I'll continue to work with him and we'll see what happens. This site offers an opportunity for a second or third set of eyes and I appreciate you all taking the time to address my concerns.

[DrPensler]

Stay active, with your body type I typically find a high percentage of glandular tissue with little fat. The absence of appreciable fat facilitates great muscular definition  but allows some adhesions to form more easily between the muscular fascia and the skin.Exercise is useful in stretching most if not all of the adhesions.As for the areas that do not respond either steroid injections into the adhesion or occasional surgical release and transposition of vascularized fat flaps are used.Good luck!