Post surgery ......advise needed on depressions and craters.....SOS

[kaps]

Dear doctors ,

I got operated for my gyno on 1st July , with a board certified plastic surgeon , who has done many gyeno operations . i also saw the results of his previous surgeries and even met few of his clients . I was very happy with the results .
In my case he did both excision and lipo , and he told me post operation tht i had too much fat , he had to remove 150ml frm both sides each .

here is the the link to my pre ops pictures

http://picasaweb.google.com/mumbai.experience/Kaps_PreOP?feat=directlink

Now after 14 days after the surgery , i am very shocked with my results , my chest looks hollow and one side the nipple is denting in , and on both the sides there are dents/depressions above the nipples towards the inner chest . I went back to the surgeon . He told me that there is some swelling and the scar tissue is causing the nipple to dent in .

As per him the scar tissue will heal and hence nipple will not dent in , and after the swelling subsides my chest will look better and with time the dents will fillin in

here is the link to my 14 days post op pictures

http://picasaweb.google.com/mumbai.experience/Kaps_PostOP?feat=directlink

he has advised me the following

Apply contractubex gel to the entire area , this will help remove the scar tissue
Sleep without my compression garment in the night but wear it in the day time .

Now situation is slightly better then tht in pictures , the nipple is not denting in as much but its still denting in but there dents above the nipple towards the inner chest are still there .

I am very very worried , and i think my chest pre op was better , i think once the swelling subsides and scar heals my nipple may get better but i am very worried about the dents which are there .

Pls advise me what can be done , is there any hope of my chest healing and looking better with time .

 if my dents dont fill in what are my options .

[Litlriki]

It sounds like you did your homework, and it is surprising in such an instance to see your post-operative photos, which I agree, are not characteristic of what we like to see even in the early post-operative period.  At this point, there is not much that you can do but wait to see how things settle down as swelling resolves, and as the scarring progresses toward a final appearance. You can manipulate the scar with compression and massage (I'm not sure why you were told to NOT wear compression, since I'd prefer compression for at least 4 weeks afterwards), and it's certainly encouraging to hear that you're seeing some improvement.  As I'm sure your surgeon will tell you, however, you shouldn't do anything surgical as an intervention for at least 6 months, and possibly longer.  Hopefully, any revision will be minor.

Good luck,

Rick Silverman

[DrBermant]

Dear doctors ,

I got operated for my gyno on 1st July , with a board certified plastic surgeon , who has done many gyeno operations . i also saw the results of his previous surgeries and even met few of his clients . I was very happy with the results .
In my case he did both excision and lipo , and he told me post operation tht i had too much fat , he had to remove 150ml frm both sides each .

here is the the link to my pre ops pictures

http://picasaweb.google.com/mumbai.experience/Kaps_PreOP?feat=directlink

Now after 14 days after the surgery , i am very shocked with my results , my chest looks hollow and one side the nipple is denting in , and on both the sides there are dents/depressions above the nipples towards the inner chest . I went back to the surgeon . He told me that there is some swelling and the scar tissue is causing the nipple to dent in .

As per him the scar tissue will heal and hence nipple will not dent in , and after the swelling subsides my chest will look better and with time the dents will fillin in

here is the link to my 14 days post op pictures

http://picasaweb.google.com/mumbai.experience/Kaps_PostOP?feat=directlink

he has advised me the following

Apply contractubex gel to the entire area , this will help remove the scar tissue
Sleep without my compression garment in the night but wear it in the day time .

Now situation is slightly better then tht in pictures , the nipple is not denting in as much but its still denting in but there dents above the nipple towards the inner chest are still there .

I am very very worried , and i think my chest pre op was better , i think once the swelling subsides and scar heals my nipple may get better but i am very worried about the dents which are there .

Pls advise me what can be done , is there any hope of my chest healing and looking better with time .

 if my dents dont fill in what are my options .

Tissues do evolve and heal after gynecomastia surgery. How much depends on the original problem, what was done, skill of the surgeon, how a patient heals, Scar Care, Compression Garments After Male Chest Surgery, and many other factors. The problem is that starting in such a poor position often jeopardizes the final result.

For the factors you checked, what was missing is seeing early after surgery pictures: what can be a critical factor in surgeon selection. If those results are typical for how your surgeon's early cases start, then you may yet get a decent result. If not, then why do your results vary from what the doctor shows patients before surgery?  Asking any doctor are the results shown typical for your surgery is valid.

Revision surgery is an art form. Not all doctors have the same skills. Picking a surgeon who performs a great deal of revision surgery has advantages of experience especially if the revisions are not on his or her own patients!  Options for revision surgery depend on many factors that usually need to wait until tissues heal.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

[kaps]

Thanks a lot doctors for your advice , well i did check some before and after pictures those results were not like mine . but my PS says that i had much more fat in my chest and every patient's results are different .

Well just wanted to understand what are my options ...

Now for next six months i can just use scar care products and kee massaging . if the results after six months are still not good what options do i have ....

I am more concerned about the dents or the depressions that i have diagonally above my nipples towards inner chest , its more on once side ...... how can these and the nipple crater can be treated ..... do i go for the fat injections to fillin the dents or do i go for more lipo arnd the dented area and suck more fat and even those places .....since i am in India may be my options will be limited ...pls guide ....as i am a water baby and love my swimming and goin to beaches , which i can't do in my current position .....

Is it safe the take off my compression garments after 4 weeks of surgery , in my current position or i should wear it for long , today its 24 days post surgery ...and my current situation is slightly better then the pictures but all the dents and nipple issue is still there ...things have only improved by 5 to 10% .

And can i start working out after i complete 4 weeks ....i was told i can start working out after 4 to 5 weeks of surgery.

[DrBermant]

Thanks a lot doctors for your advice , well i did check some before and after pictures those results were not like mine . but my PS says that i had much more fat in my chest and every patient's results are different .

Well just wanted to understand what are my options ...

Now for next six months i can just use scar care products and kee massaging . if the results after six months are still not good what options do i have ....

I am more concerned about the dents or the depressions that i have diagonally above my nipples towards inner chest , its more on once side ...... how can these and the nipple crater can be treated ..... do i go for the fat injections to fillin the dents or do i go for more lipo arnd the dented area and suck more fat and even those places .....since i am in India may be my options will be limited ...pls guide ....as i am a water baby and love my swimming and goin to beaches , which i can't do in my current position .....

Is it safe the take off my compression garments after 4 weeks of surgery , in my current position or i should wear it for long , today its 24 days post surgery ...and my current situation is slightly better then the pictures but all the dents and nipple issue is still there ...things have only improved by 5 to 10% .

And can i start working out after i complete 4 weeks ....i was told i can start working out after 4 to 5 weeks of surgery.

Options depend on what resources remain, what damage was done by the surgery, the original problem, and many other factors which we help patients explore during consultations or preliminary remote discussions.

I do not offer fat grafting. I do not like how the results look on animation. Since I do not offer the operation, that is why it is not featured on my website. However, I have seen many many unhappy patients from other doctors with fat grafts on their chests from other surgeons.  This past week I worked with 3 different patients unhappy after other surgeons' misadventures with fat grafts to the chest.

The problem is getting pictures / movies of patients who have come to me with such disasters. Someone comes into my office and I do not have something to offer: oh lets grab the camera so we can show your disaster to the world!  Instead of making that patient feel bad, I prefer to accentuate the positives helping them as much as I can.

You may have also seen some patients with fat grafts moving. Lips filled with fat grafts can have an animation problem.  When you see someone with filled out lips that seem rubbery and not moving well, that is something of a horror show in my opinion.  But then some will paralyze their face with botox and seem happy with the lack of animation!  (Something also that I do not offer.)  You may have noticed that those pushing their botox "solutions" also do not show how tissues move before after. 

Since I am not "selling" this operation, the proof that it works should come from someone who claims that it does.    Yet someday I may just go ahead and post one of these disasters that comes to me that I revise.

Be careful of someone claiming that their fat graft surgery works, check documentation of before / after.
You will want to see what happens as the areola muscle relaxes, is there still a good contour.  Bad contour problems can easily be hidden with a cold room or areola muscle stimulation.. A filled out profile can look better on a few photographs that may not be the case from other views.  Try to find at least a Set of Standard after Gynecomastia Surgery Pictures that shows what the results looks like with the arms up over the head and flexing muscles. The quality of the results may also not sufficient with how tissues move in animation. When I see Before and After Gynecomastia Revision Videos or Movies or a patient in person that shows improvement, then I will reconsider my opinion.  However, that will be one case in contrast to the many disasters I have already seen over the years.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery