Revision Surgery with Dr. Jacobs - Fat flaps + scar excision

[newuser8]

I had my original surgery on June 8th 2017. It resulted with a crater on my right and a hypertrophic scar on my left.


Fast forward a year and I have booked a revision with Dr. Jacobs. Dr. Jacobs really needs no introduction here. Everyone here should know of his world class primary and secondary treatments of gynecomastia. I have researched relentlessly over the past 10 months about revisions and poured over reviews, contacted people online and offline, got multiple consultations (9 in total!), and medical journals in an attempt to secure a good outcome this time. I needed to choose someone that is as invested into gynecomastia as I am. I find it reassuring that Dr. Jacobs visits this forum nearly every day and has amassed thousands of posts.

I do believe that fat flaps are the best chance I have in fixing my crater. I apparently have excess tissue both above and below the areola to perform the fat flap procedure. The best thing about this is that there is no wishful thinking needed as there is in fat grafting. The issue can be resolved immediately on the operating table.

I have attached a few pictures here showing the crater. Here is an album with extensive pictures showcasing the problem.

https://imgur.com/a/XYm0EEb

My original case was pretty minor - or so I thought. I now have adhesions under my crater that I can sometimes feel when I stretch my hand all the way back. It is from the adhesions that cause the nipple complex to adhere to the underlying muscle when tensed. I imagine that the scar adhesions will need to be removed and then fat flaps rotated into the void so that the skin can glide along top of it to appear normal.

My goal for the first surgery was to have the puffiness in shirts to go away. This was achieved, however now I'm unconformable without a shirt. The goal of the secondary surgery will be to fix the crater with fat flaps, and then excise the hypertrophic scar on my left. I will also be receiving liposuction to remove excess tissue on both sides. I was hesitant in the first place to receive lipo, but that got me in trouble with the first doctor who did excision only so I'm going to do lipo this time.

I created this post in an attempt to consolidate all of the private messages I have received here and elsewhere since many have wished to follow my progress before they also bite the bullet for another procedure. The surgery date is October 4th, 2018. Wish me luck!

[ajiet]

All the best for your revision surgery. Done mine on June 12th '18 and cursing myself everyday to have done this surgery.
My complication is nowhere as bad as yours. My right nipple is normal with just a little more fat sucked out from above andmedial side of areola. On the left side I'm not able to figure out how it's going to shape up because that side got a seroma which continued for 6 weeks and swelling is still there. Maybe that is causing the left nipple into folding. It becomes normal when stimulated but folds in once relaxed. I doubt the left side was not lipoed at all.
For now, nothing is in my hands and I'm waiting it out until mid October when I'll be 4 months out.
I will follow your thread closely and update with what I do. Not going to sit and watch for months and years and eternity. Something has to be done.
Once again, my best wishes to you.

[Calabria]

Please update us. My case is very close to yours. And im about to do fat grafting.
Id like to go on fat flap but where i live the docs only says to do fat grafting.

[Cristalis]

Man, i opened the link with your pictures! You looked so good prior to surgery, in my opinion there were no glands! Why you had it done i dont dont really understand!?

[joe7]

Wish you the best for this revision and look forward to seeing your results. I am considering a revision a few years down the line and Jacobs will be around the top of my list for potential surgeons.

[newuser8]

My surgery was actually moved to October 11th. And yes, I ultimately should not have done the original surgery and it was honestly the worst mistake I have ever made in my entire life, but I have learned lots from this and so it wasn't a total waste. I took a great interest in learning all about Gynecomastia surgery after my original botched procedure. This also led me to seek treatment by Dr. Jacobs in hopes of resurrecting a decent outcome for the 2nd time around.

Anyways, today is the 3 week mark. My results are simply A-M-A-Z-I-N-G. I'm holding out until the 6 week mark or more until I can claim victory, but so far so good!
I'll do a more comprehensive write-up later when everything is healed. For now I'll post my scars and some pics of my crater (or what used to be it!)
I am limited to 4 images per post, so I'll post more in the post below.

To recap: Scar revision on my left side with fat flaps to correct bi-lateral craters plus additional lipo on both sides to contour and get rid of the extra tissue. The crater on my right was severe. The crater on my left wasn't too shabby and I wasn't concerned about it until Dr. Jacobs pointed it out and said he was going to fix it while he was in there.

The Surgery:
No complications. "Surgery went as well as it could have gone" is what was told to me. Dr. Jacobs gave a short debriefing of everything and even showed me a colored picture of the craters before and immediately following surgery. I felt great afterwards knowing I was well on my way.

Next Day:
I didn't need to use any pain meds. No bruising. Sleeping sucked plus the binder was rough to deal with, but that was expected. It wasn't my first rodeo.

I met with Dr. Jacobs again and he personally went over how to care for the wounds and took off the bandages and reapplied them. Note: My last surgeon, and many other surgeons, simply have an assistant do this with zero face time with the doctor. This was really good care in my opinion.

I didn't want to look at the results right away because I hated looking at my chest for the past 12 months. I ended up doing it right then and there and I was super happy to see the incisions. They appeared to be cut using a super sharp hot butter knife compared to my first surgeon's incisions. I'm not exaggerating...please look at my first OP incisions lol.  The skill really showed here.

I sit in bed for the remainder of my time in NYC. I was anxious to see stuff, but alas. I flew back to Arizona with little trouble.

3 Week:
I didn't drive for 1 week and I still can't lift my arms completely overhead. I'm being super cautions here so as to not ruin the incisions and stretch them. I've also been changing the bandages everyday for the first 18 days. Keeping the wounds moist and covered is a good strategy to make sure the incisions heal nicely. I didn't want them to scab which created terrible scars the first time. I've also been taking the supplements as outlined in the instructions. I should mention that Dr. Jacob's post-op instructions are 7 pages long compared to my first surgeon's 7 bullet points. Not joking here.

The tissue is still bruised ever since the post 48-hour mark. They feel super hard like bricks. I think this is because revisions are tougher on the body and their is loads of scar tissue. I'll post better pictures when this heals up more.

Please note below in the pictures the following:

1. Post 48-hour mark picture was me slouched over because I couldn't stand all the way up. Some blood collected around some spots due to the tightness of the binder.

2. My lipo scars are invisible. I never imagined they would turn out this well considering my first OP.

3. The incision on my right looks amazing. The old scar wasn't too bad here, but nonetheless it was removed as well I think.

4. The crater is gone! I can lift my arm all the way up and there is no indent. Still too early to tell 100% tho.

5. Craters are somewhat hard to show. Mine was severe so I hope it is clear to see the difference right now.

6. Those are silicone pads that I am wearing to help with the scars.

[newuser8]

Please look at the difference between these two scars! There is some obvious healing still occurring and dry skin flaking off, but the scar revision result should already be apparent. It is like magic. I was told the entire scar would probably not be excised. I think this was the best route. I accurately predicted that this would happen with some scar at the widest point being left alone, but pulled much closer to the areola so as to make it harder to spot. I'm please with the result thus far - it couldn't have gone better at this point.

I could always look into medical tattooing in the future if I became super picky to make it look better. I'm not in any rush to do any such procedure.

Long story short to anyone who currently has a crater: Be careful with your options. I've talked to probably around 10 patients on and off these boards about craters and anyone who received fat injections had a bad experience. At best, someone said it improved 10%. One other person is yet to receive fillers. 7 of the 9 surgeons I interviewed recommend fat grafting or just lipo to even everything out which would have taken away the resources necessary for Dr. Jacobs to do the bi-lateral fat flaps. One guy turned me down for a revision. I don't mean to sound pompous, but I am fairly confident to say most plastic surgeons are no exception to the 80%/20% rule in which 80% are clueless and subpar at their work. And that 20% pool shrinks drastically even more when it comes to experts in gynecomastia. Now imagine the size of that pool of plastic surgeons when even further experience is required to fix craters! You really do have to do your research and protect yourself out there. I can go on and on about this subject and what I've uncovered, but I'll stop

Dr. Jacobs is pretty much your best option to get an awesome revision result when it comes to craters. Try fat flaps first before anything guys. I really feel for people in my predicament - it sucks. I am simply in disbelief on the cosmetic industry - mind boggling (more on this later). I am extremely jealous of people who go to expert gyno surgeons for their first procedure and have an excellent result and go on with their lives. They have no idea what they dodged...

To recap my 3 week update: Excellent results thus far from Dr. Elliot Jacobs on Park Avenue NYC and look forward to even better results to come.

[DannyH]

Hi there newuser8, please keep us posted, are there any new frontal shots like the very last one you posted ?(48 hours post op)

I mean shots that give a view when standing approx. 2 or 3 metres away?

Please let us know how it is looking now. Thanks in advance. Thanks for coming back to do this.

[newuser8]

I'll post some more in 4 weeks. The scars and tissues will look much more natural at that point than now. I plan on wearing the pressure garment for 6 to 8 weeks total. I'm almost to week 4 so I have loads of healing to go.

[joe7]

Your results look really promising even this early - it looks like the crater has been completely resolved - nice! Thanks for the detailed write up and look forward to seeing how things progress as you heal.

[DannyH]

I'll post some more in 4 weeks. The scars and tissues will look much more natural at that point than now. I plan on wearing the pressure garment for 6 to 8 weeks total. I'm almost to week 4 so I have loads of healing to go.

Thank you. I think you deserve a Nobel Prize for wearing a pressure garment for that long. I speak for everyone in saying l'd really like a daily / every other day pic update. Keep on keeping on!

[DannyH]

I'll post some more in 4 weeks. The scars and tissues will look much more natural at that point than now. I plan on wearing the pressure garment for 6 to 8 weeks total. I'm almost to week 4 so I have loads of healing to go.

It's been quite a while now, any news?

[Cristalis]

Wish i could have had your prior to operation chest, you were great man. Now you spent a lot of money on two surgeries and look botched, im so sorry you havent been happy with your look of your chest. First doctor should have sent you home but no, they want money so he butchered that nice chest!

Sorry man, trully im.

[newuser8]

I attached 3 pics showing relaxed, flexed, and then arms raised and extended in an awkward pose. Please note that my chest has always been asymmetrical with one side being bigger than the other since birth. The casual observer probably won't notice, but I'm just pointing it out. Surgery kept this ratio which I think shows a natural appearance.

The scars are 100% improved, and I'm very happy with them. My left side has some scar tissue that will need 1 or 2 injections, but other than that the contour is near perfect and I'm happy with it. The right side, which is where the crater was bad, has been greatly improved. I'd say anywhere from 70-90% depending on the pose or my mood that day. I can raise my arm and there is no crater visible and no tethering. Flexing and bringing my arm up and towards the sternum will show the crater at its worst. There is still a lack of tissue for sure, however it is much better than last time. The additional lipo blended the area so the depression looks less. No one would be able to tell I have a crater there, even the most trained eye. I'll be returning to Dr. Jacobs hopefully sometime soon for injections and pictures to complete the process and hopefully help others in the future.

The only thing on my mind right now is a pulling sensation on my right which happens when I flex. Hopefully it will abate with time. If I were to try to get it all the way filled, I would have to go with a dermal (Allomax) or adipose (Renuva) donor tissue filler. I'm not rushing into anything anytime soon.

This will be my last post and last answers to PM. I'm sure you understand, but I'm going to move on for now.
Best wishes!

[Cristalis]

Dr Jacobs did a very good job with the revision, you look much much better now!!