Partial Fat Flap

[spooreal]

Hello.

I was wondering if there is not enough fat to bridge two flaps, can you create a one sided flap and sew it to the skin or tissue to partially fix a defect?

I ask this bc there is a crater type defect and there is a hole. The edges are clearly defined, eg like a clif. I know a gradual edge sloping into a hole will be less noticeable, but I am concerned about taking more fat out to create this. So, rather than creating a bigger hole, I would like to make the hole smaller by using the fat around it to slope. 

Any help or comments would be appreciated.

[spooreal]

Hello.

I was wondering if there is not enough fat to bridge two flaps, can you create a one sided flap and sew it to the skin or tissue to partially fix a defect?

I ask this bc there is a crater type defect and there is a hole. The edges are clearly defined, eg like a clif. I know a gradual edge sloping into a hole will be less noticeable, but I am concerned about taking more fat out to create this. So, rather than creating a bigger hole, I would like to make the hole smaller by using the fat around it to slope. 

Any help or comments would be appreciated.

I would like to clarify, there is a crater defect which is a hole... the edges are defined, without slope.

[Litlriki]

Post some photos.  It's tough to understand what you're talking about.

Rick Silverman

[Dr. Elliot Jacobs]

Posting photos would be most helpful -- it will help us help you.

There are many ways plastic surgeons can do fat flaps -- it depends on the availability of the surrounding tissues and the extent and depth of the crater itself.  If there is a very deep crater, then fat flaps can be developed from several different direction and sutured on top of one another to build up the tissue in the crater.  Other times, one need only advance the flaps and suture then tip to tip.

Best to leave the technical details to an experienced gyne surgeon.

Dr Jacobs

[spooreal]

Hello. THANKS SO MUCH FOR YOUR REPLIES.

So I should give some background. The photos are a result of three surgeries within the past year. 1. Lipo and gland excision that was generally a success except residual tissue below my nipple. 2. Instead of removing it, my doctor lipo'ed the area dry. The defect was still there and the tissue moved and I felt some sticking inside my chest where the tissue remained. 3. I had the tissue removed.

Result: A burn through my skin which has heal for the most part(not concerned now, but its an issue) and (my concern as of now) A strong adhesion below my nipple which is stuck to muscle and to tissue under and slightly below the nipple. It creates a rim or lip underneath that is noticeable as the contour is off and a shadow is created. Under the skin is void of fat and when I pinch and rub, its very rubbery.

1st photo is relaxed
2nd photo is flexed

I need help. Ideas would help, but I also would like a consult with someone experienced who is confident they can fix this.

Thanks Docs.

[Litlriki]

Thanks for posting the photos.  My first thought is that you should leave this alone for a while--six months at least, and possibly massage the area and let the tissues soften.  It's a challenge to do revision surgery, and if the tissues are stiff and scarred, the challenge is even greater.  Once things have softened, releasing the scar and pulling some fat into the defect should be effective.  The photos only provide so much information, and a physical exam would be helpful to really understand the extent of scar and the adequacy of the surrounding tissue, but it looks like there should be adequate tissue around.

Rick Silverman

[Dr. Elliot Jacobs]

Agree with Dr. Silverman -- many months of healing are needed for the tissues to mature and soften.

What is worrisome though is the burned skin just below the areola.  Was this due to the surgery (did the surgeon use laser lipo or ultrasonic lip?) or was it an accident completely separate from the surgery itself?  That burn must heal completely before any further surgery can be contemplated.

After it has healed, you should visit an experienced gyne surgeon to assess how much available fat tissue is present so that fat flaps might be considered.  If there really is no available fat, then one could consider one or several fat grafting procedures. 

Good luck!

Dr Jacobs

[DrPensler]

I would agree with Drs Silverman and Jacobs.At this point there is a lot of scar from repeated procedures and you need to let everything settle down.I think you should see an experienced surgeon if there is still a problem and let him /her devise a treatment plan rather than attempting to micromanage the process yourself.I understand its tough after three surgeries but with each surgery there is more scar build up and hence a longer time interval is required for maturation.