Author Topic: Gyne Chest Revision Question  (Read 4525 times)

Offline Allhopeaside

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My Doc has agreed to perform an additional procedure due to the fact that I was not happy with my original results. I am about 6 months post op. He has told me that he will be "injecting fat directly into the chest" to help even out a some cratering on the left side of my chest. Does anyone know anything about this type of procedure? Sucess rate in particular? Hoping a doc can weigh in or anyone with some experience, thanks alot.
AM I NOT A BETTER MAN?
A MAN WHO HAS GROWN SOUND AND STRONG
A MAN WHO HAS LEARNED FROM HIS MISERY
AM I NOT A BETTER MAN?
A CLEVER MAN WHO TAUGHT HIS FLESH THE WAY OF STEEL THIS LASTING MAN OF RESOLVE AND WILL
AM I NOT A BETTER MAN?
OR JUST A BITTER MAN
THAT ROTS WITH MEMORIES AND ONLY GROWS COLD

INDEED I HAVE GROWN COLD

DrBermant

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My Doc has agreed to perform an additional procedure due to the fact that I was not happy with my original results. I am about 6 months post op. He has told me that he will be "injecting fat directly into the chest" to help even out a some cratering on the left side of my chest. Does anyone know anything about this type of procedure? Sucess rate in particular? Hoping a doc can weigh in or anyone with some experience, thanks alot.

Here is an answer I posted to a similar question:

Dr. Bermant,

Could you reflect your opinions on the following questions -

- When you speak of fat grafts - they cover both terms - live fat grafts as well as fat transfers, right? Are there no other ways of soft tissue implants.

- Also There is some hype about stem cells being mixed with fat cells to increase the acceptance of grafts. Do you think, that would be helpful for patients like us (those who dont have enough fat on chest.)
http://www.cytoritx.com/

- Bio-alcamid has been promoted as a permanent filler for soft tissue defects. What are your opinions on it. Some before and after pics located here - http://ascentemedical.com/content/view/45/223/

- There is a newer trend about pec implants, what are your opinions?

- To be very honest I really dont mind having smaller male boobs (really tiny fillers as that probably look more natural) than to have craters which look terrible.

Thanks.

Options for revision of Crater Deformity Scars after Gynecomastia Surgery depend on the original problem, what was done, what resources are left, after care, scar care, how the patient healed, and many other factors best explored during an evaluation.  I prefer to leave a natural layer of fat between the skin and the muscle that preserves natural motion of tissues.  When the layers scar together and there are adequate resources to revise the scars, then revision surgery may be an option.  I have revised many such deformities from other doctor's operations. Unfortunately I also have seen so many other patients where there is just nothing left to rebuild with.  A Fat Flap Gynecomastia Sculpture takes nearby fat, trying to maintain its blood supply, and filling the defect with living fat.   Fat taken from other parts of the boy without a blood supply are grafts.  A good deal of such transferred fat dies and usually becomes firm.  This firm tissue can be just as firm as other scars or gland and does not look good especially on animation.  The fat flap moves like normal fat.

Firm fat, dermal fillers, and molded implants all can have values for scars, but just do not look good on tissues that are supposed to move.

The photographs on the second link you quoted (at the time of my review today) are examples of what I call inconclusive evidence.  Notice how the lighting (and sometimes the angle of) photograph has changed.  The before images use lighting to accentuate shadows and deformity.  The afters use lighting that hides shadows and craters.  They also do not show how the tissues looks on animation.  Watching tissues move, as in a volleyball player's exposed chest, is proof of the effectiveness of a technique. 

Making something look good for a still picture can be a partial achievement.  It reminds me of the story of the fantastic prosthetic ear for the patient missing an ear.  It looks great until it falls off during a dinner party into a soup bowl!  Each option has its limitations.  I have never seen fat grafts used with any technique that look adequate on animation.  That includes work from those teaching such techniques at meetings.  Watching them move in person or movies tells the story to me.  The results of even the field's experts are just not something I like and so do not offer.  Our field of plastic surgery keeps on moving forward with evolution in techniques.  I am looking forward to the day that such techniques really offer a satisfactory solution.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia for Chest Deformity after Surgery

Offline sabercut

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I have some questions

1. Is it worth a try. I mean if it stays and and the motion is really bad, it can be excavated out, right and things will be back to square one.

What do you think.

DrBermant

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I have some questions

1. Is it worth a try. I mean if it stays and and the motion is really bad, it can be excavated out, right and things will be back to square one.

What do you think.

If you mean digging a hole deeper, no that only worsens such a deformity.  Typically reconstruction involves filling in a defect if adjacent resources are available. 

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

Offline sabercut

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I meant fat graft. If fat is grafted, and some of it stays, and lets say the animation looks really bad (something unnatural + scarring), this grafted fat can be taken out, right.

Then things will be back to square one - where you started from (having crater deformities), right?

DrBermant

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I meant fat graft. If fat is grafted, and some of it stays, and lets say the animation looks really bad (something unnatural + scarring), this grafted fat can be taken out, right.

Then things will be back to square one - where you started from (having crater deformities), right?

Fat grafts are often diffusely spread out to maximize chance of survival.  Removal of the diffuse thickened component can be difficult to impossible.  I have seen such disasters from misadventures of other surgeons.  Removal can create a worse defect.  It is a matter of compromise.  Such issues are best explored during a consultation after learning more details about the problem.

Hope this helps,

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


 

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