Post surgery crater

[BB2012]

So I have had puffy nipples since I was 12 like many people on this site, I am now 24 and two weeks ago I chose to have it removed.  I had very low body fat(prior to Thanksgiving + no exercise due to surgery) and my doctor said it would be a simple case and we discussed that it was better for him to be conservative because I was very worried about cratering.  He did gland excision with no lipo because he felt I didn't have enough fat to take any away.  However, I am two weeks out and there is a very clear 3-4" depression around my left nipple.  It gets even worse when I move or flex my chest.  I have heard of swelling going down months after the surgery but is it normal to have indentation so soon or did the Dr. take out too much tissue?  Also the borders of the depression are very firm unlike the other side which is a bit swollen and squishy.  
I am a personal trainer and I have been looking forward to exercising and training without a shirt but now worried I will be just as self conscious as before.

I know it is early and everyone heals different but I would like to know if this gets beter with time and if not what my options are.  Thanks!

[Dr. Elliot Jacobs]

Two weeks is much to early to judge any results.  Oftentimes, there may be swelling on various areas of the chest, which, by contrast, make some of the normal areas appear like a crater.

Best to delay final judgment for at least 4-6 months.  In the meantime, you should see your surgeon for routine follow-up and discuss the situation.

Dr Jacobs

[BB2012]

So I talked to my Dr. today and basically he admitted to taking too much out on the left side.  He also recommended me to wait a few months to see how it heals, but he feels some residual gland left under the nipple along with excision of the gland around it hence the crater appearance.  He also said I would need revision surgery to fully correct the problem, awesome!
So what realistic options are there for such a large deformity mid chest? 

[Dr. Elliot Jacobs]

First, glad you spoke with your surgeon and received an honest opinion from him.

Best option is to wait and allow maximum healing to occur.  While a crater may not improve dramatically, it might improve somewhat, which would make the prospects of a revision operation less daunting.

Revision surgery to fill in a crater is obviously determined by what residual, surrounding tissue is available.  If there is some tissue, then potentially some subcutaneous fat flaps could be used to fill in the defect.  If there is minimal surrounding tissues, then one or more fat grafting procedures might be used.  And sometimes there is a combination of limited liposuction to reduce the surrounding "hills" while using the remainder of the surrounding tissues to fill in the "valley."

And rarely, and unfortunately, there may not be anything that can be done.

Best to be optimistic and give yourself plenty of time to heal.

Good luck!

Dr Jacobs

[BB2012]

Another question for the Dr.'s! So around the crater area is very firm and tender tissue.  I have been researching and it sounds like this could be scar tissue.  Should I be massaging this tissue?

[DrPensler]

You are still very early after surgery.Some of the firmness is swelling and some may be scar but it is a bit early for significant scar tissue.Basically at this point you need to let everything settle.Wear your garment and sit tight for a few months.

[Litlriki]

I encourage my patients to massage the operative site post-operatively, gently at first and a little deeper over time, as pain resolves.  This helps to break up scar tissue and helps with the resolution of swelling, so that the eventual result is supple skin that moves over the underlying muscle.  You should speak with your surgeon before proceeding with that.

Rick Silverman

[BB2012]

So it's been about 4 weeks since the surgery and the left side seems to be getting worse as the swelling and bruising subsides.  Since my doctor doesn't have much revision experience he couldn't tell me if the problem could be corrected or if it is too severe.  I attached some more pictures at an angle so you can really get a since of the shape and depth of the crater.  To me it feels like he tried lipo on this side realized he messed up and just stitched it back together.  The gland is still prominent under the left nipple while the right seems very smooth.  Also, like I stated earlier the areas where the crater ends feels hard, I can almost grab the edge of the fat wall.  I know it is still early but from the amount of difference between the crater and the tissue above it I don't feel like it is going to change much over time.
 I know the most common techniques are the fat flap and fat graft but are these enough to fill this space? It is over a 1/4 inch difference in depth.  Also, if it's possible to tell from the pictures would you Dr.'s feel confident that a revision would yield a good result in the right hands?

[BB2012]

Here is another

[Dr. Elliot Jacobs]

Again, at four weeks, it is much much to early to be panicking and thinking about revision.  We understand your frustration but at this time there is only one thing to do:  sit on your hands and do nothing.

You really need to give everything a minimum of six months for the tissues to heal, swelling to settle down and for the results to evolve.  Then consult with your surgeon and if he feels he cannot help you, then consider seeing another surgeon who is expert in revisions.

Dr Jacobs

[Litlriki]

I would echo Dr. Jacobs.  You need to allow time for the healing process to proceed.  If there isn't adequate improvement, a combination of liposuction of the area above the crater (or around it) and some fat grafting into the area where the crater is most apparent can certainly lessen the deformity in its current form.

RS

[BB2012]

Thanks for taking the time to reply! I'm going to try and take your advice and try to put it out of my mind for the next few months until there is something I can do about it. 

[BB2012]

Hello Dr's I'm back with some more questions.  It has been over three months since my surgery and the results have not progressed since the one month photos I posted earlier.  The left and right nipples still have hard tissue underneath and I still have a large depression around the left nipple.  The nipple now sticks out more than it did pre-op, or at least appears that way next to the depression.  Since the depression is very noticeable I am still wearing compression to conceal it, and I am back at the gym full swing.  When I take the compression vest off for a few hours my nipples seem to get swollen and puffy, worse than before the surgery.

 As far as exercise goes my right side feels relatively normal but a bit tight when I stretch my arm up and back, however, the left side is very painful when stretching.  It feels like the tissue underneath the nipple is tight and if I were to move it all the way back I could tear something.  Should I continue to stretch it or leave it be?

Thanks for the replies!

[Litlriki]

I am generally a fan of massage and stretching to improve range of motion and to help with localized swelling, so I'd probably encourage you to continue with those maneuvers.  You'll want the tissues to be softened and supple before undergoing any sort of revision surgery.

RS

[BB2012]

So I am almost at the 6 month mark and I am going to schedule consultations with some of the more well known surgeons in the LA area, such as Dr. Kapoor, Dr. Cruise, as well as Dr. Teitelbaum to see what they say they can do for me.  I'm updating the pictures and was wondering what you Dr.'s would suggest for surgery, and if you think I am a good candidate for a revision.  My main concern is the left side in which the nipple seems to be even more puffy than it was before the surgery accompanied by a wide area of uneven tissue.  However, I feel like the right side still has a pretty big lump under it which is noticeable on movement and could use some reduction as well.
Thanks for all the help.