revision question

[Ride09]

I had surgery a year ago for puffy nipples, still pretty unhappy with the results. I talked to a doctor who I feel confident with to do the revision, but his plan of action struck me as a little odd so I wanted to know if it made sense to you doctors on here. The pictures included are my chest on both sides when flexed, and the problem is my left nipple is being completely pulled in by scar tissue (due to over resection...and the right side is being pulled in by scar tissue but it only on the top half leaving the crease you can see in the picture. 

His plan of action: he said the best solution would be cut about 1/4 inch of skin below each nipple, use fat grafts for support under the nipple, and then reattach it to the new spot a bit lower.

Of all the revisions I have read I haven't heard of any doctors cutting a little excess skin and basically stretching the nipple.  He said this would change the shape of the nipple to be more circular than oval shaped. Have you guys done this technique on any revisions? Any opinions you can give me? Appreciate any of you who take the time to read all this

[Ride09]

well apparently it is impossible to put a picture up on this website

[Litlriki]

Photos would help a lot.  I wouldn't cut out skin to make the nipple a different shape--they are often oval shaped rather than perfectly round, so that's not a reason to take skin away.  Mobilizing the scarred tissue and pulling fat flaps together under the skin might be an option.  I'd go through the original incision if I could. 

Anyway, figure out how to post the pictures, and I think you'll get more valuable feedback.

Rick Silverman

[Ride09]

Appreciate the input, i've been trying all afternoon to try and get these pictures up but this is the only luck i've had. this is a link to the pictures. left and right pecs while flexed, while relaxed, and while hands are overhead. (the link doesn't include the "[IMG]" but that was the only way this website will let you put a link in a comment. [IMG]http://imageshack.us/user/ride09[IMG]

[DrPensler]

Revisions are always difficult and each case is unique. It is likely you will never be perfect in every view and in every instance of muscular contraction. It would be highly unusual for me to excise skin in the absence of substantial skin excess.

[Ride09]

I agree with you Dr. Pensler with the fact that ill probably never have perfection, that's fine with me. But I feel just as bad about my chest as I did before having the surgery...my surgeon described this as "90-95%" for the results. He also said it was "unnoticeable". Not having a perfect chest is fine with me, I just think it would be cool to have a nipple that doesn't disappear every time my chest muscle flexes. I appreciate the info though this site has really been alot of help

[Litlriki]

Based on the photos, I would not remove any skin, but either fat grafting or fat flaps might help to prevent the nipple from indenting to the extent that it does.  Creases in the nipple and lax nipple skin often result in patients who had particularly puffy nipples pre-operatively.

RS

[DrPensler]

I would, after looking at the photos, agree entirely with Dr. Silverman.You should realize that fat grafting is a bit unpredictable.