Repairing left side Crater

[Ali19]

I had surgery about 13 months ago, very happy in the sense I don't have gyno any more, with that being said I'm quite unhappy with my left side.

Left side looked worse than the right side (as far as crater goes) ever since day one, I remember taking off my garment after two three weeks and being like this better not be a crater, waited out the entire last year and left side is still a crater.

While standing up it's not really noticeable, however even a little flex of the left side or sitting down the crater is clearly there.

I've booked an appointment with my surgeon, can I get your guy's take on my case as well, which flap procedure would be best for me?

[Dr. Elliot Jacobs]

At 13 months post op, what you see is what you got.

You are correct in first returning to your surgeon -- he knows what was done and is in the best position to help you.  On the other hand, you might also benefit from seeking at least one addition opinion, preferably from a gyne expert.

From the photos you included, it appears that your skin may be adherent and that there may be a deficiency of tissue under the left areola (ie a crater deformity).  In patients similar to you, I have opted for a fat flap to fill in the deficient tissue -- but that depends on the availability of adjacent tissue -- only a physical exam can determine that.

Good luck!

Dr Jacobs

[Ali19]

At 13 months post op, what you see is what you got.

You are correct in first returning to your surgeon -- he knows what was done and is in the best position to help you.  On the other hand, you might also benefit from seeking at least one addition opinion, preferably from a gyne expert.

From the photos you included, it appears that your skin may be adherent and that there may be a deficiency of tissue under the left areola (ie a crater deformity).  In patients similar to you, I have opted for a fat flap to fill in the deficient tissue -- but that depends on the availability of adjacent tissue -- only a physical exam can determine that.

Good luck!

Dr Jacobs

Thank you Doc but what if there isn't enough adjacent tissue then what would you suggest next instead of fat flap?

I completely understand my surgeon will make the final call, but I would like some suggestions as well so I can keep them in the back of my head for my own comfort.

[Dr. Elliot Jacobs]

Fat flaps have always been my "go to" procedure for revisions.  And, among hundreds of revisions, I have never failed to be able to find some tissue to use as a fat flap -- but there is always a first time.

If a fat flap is not available, then fat grafting is a second choice.  After that, there is not much that can be done.

Dr Jacobs

[Ali19]

Fat flaps have always been my "go to" procedure for revisions.  And, among hundreds of revisions, I have never failed to be able to find some tissue to use as a fat flap -- but there is always a first time.

If a fat flap is not available, then fat grafting is a second choice.  After that, there is not much that can be done.

Dr Jacobs

Cool Cool thanks again!

[Ali19]

Fat flaps have always been my "go to" procedure for revisions.  And, among hundreds of revisions, I have never failed to be able to find some tissue to use as a fat flap -- but there is always a first time.

If a fat flap is not available, then fat grafting is a second choice.  After that, there is not much that can be done.

Dr Jacobs

Hi Dr. Elliot,

I had my appointment with my PS the other day and he is somewhat hesitant to fix my crater, he says that he's not sure if a flap procedure or whatever will even fix my crater completely, to tell you the truth he does not even consider my left side as a crater, this is because the crater is mostly evident when I flex and am sitting down/stretching.

He said that because the crater is not evident otherwise it is not really a crater because the chest looks normal if I'm not making "these weird flexes", he gave me botox injections in the area and said it can take 3 months for the results to show if any and keep massaging the area to break more of the scar tissue that may be left over and come see him again a few months down the road.

He also said that because I've had 2 surgeries prior the left side looking like this can be normal.

Are these all red flags? Can my crater or "no crater" according to him not be repaired?

I think the photos got taken down or expired, please let me know If I should upload again

[Dr. Elliot Jacobs]

I would question how many revisions he has performed and if so, how many with fat flaps.

Also, I have no idea what rationale he used to inject Botox.  Botox only works on muscles to weaken them -- and the effects work within a few days and disappear within 3-4 months. I have no idea why he thought Botox could improve a crater deformity.  Are you sure it was Botox and not something else??

Dr Jacobs

[Ali19]

I would question how many revisions he has performed and if so, how many with fat flaps.

Also, I have no idea what rationale he used to inject Botox.  Botox only works on muscles to weaken them -- and the effects work within a few days and disappear within 3-4 months. I have no idea why he thought Botox could improve a crater deformity.  Are you sure it was Botox and not something else??

Dr Jacobs

Ummm I meant to refer to those injections that get injected to break down scar tissue?

I don't know why I said botox, but aren't they called Kenalog injections or something, I don't know the exact term.

[Dr. Elliot Jacobs]

OK, Kenalog makes more sense.

However, Kenalog works to soften and melt away scar tissue.  Don't know why it would be used for a crater deformity where there is already a deficiency of tissue.

Perhaps he injected it into surrounding areas?

Dr Jacobs

[Ali19]

OK, Kenalog makes more sense.

However, Kenalog works to soften and melt away scar tissue.  Don't know why it would be used for a crater deformity where there is already a deficiency of tissue.

Perhaps he injected it into surrounding areas?

Dr Jacobs

Yes, in the surrounding areas next to the nipple pretty much (the area where the skin is dent into the body due to the crater).

I understand you will not sway any patient away from their surgeon, but in your opinion is my crater something that can definitely be repaired? if not definite of course I assume the chances of repairing a crater are still quite high?

Why is my PS so un confident in his abilities to repair my crater is something I don't understand.

[Dr. Elliot Jacobs]

Can't answer for your own surgeon.

Suggest you get a second opinion from a gyne expert about feasibility of repairing your problem.

Dr Jacobs

[Ali19]

Can't answer for your own surgeon.

Suggest you get a second opinion from a gyne expert about feasibility of repairing your problem.

Dr Jacobs

Ok will do.