Any guys here who did fat grafting/transfer to the chest?

[decimal]

My doctor seemed to have been overzealous with the fat/gland removal part, and I am left with a very weak and tender feeling extremely bony chest that pains even after 13 months of surgery.

I was wondering if anyone else has had such issues, and if yes, then were they able to get it treated.

I think fat grafting might be the only option for me, but I have heard a lot of negative things about it. So I wanted to know from someone knowledgeable first hand.

Thanks

[decimal]

Any victims here of excessive liposuction that were able to get fat transferred successfully to the chest?

Thanks

[decimal]

Dear Doctors,

I might need fat grafting to fill a depression that has been left from my first lipo/excision surgery.

My questions are:

1) What happens to the donor site from where the fat is harvested? What prevents it from becoming dented/hollowed/wrinkled just like the target area that we are trying to correct?

2) Also, the bottom left of my right pec feels very bony and weak towards the center of the chest wall. Is this a sign of excessive liposuction, and can this be corrected?

3) I also feel tightness and pain in my right pec whenever I fold my arms behind my back. This is the case 13 months after surgery. What could be the cause of this, and can this be corrected?

Thanks

[DrBermant]

My doctor seemed to have been overzealous with the fat/gland removal part, and I am left with a very weak and tender feeling extremely bony chest that pains even after 13 months of surgery.

I was wondering if anyone else has had such issues, and if yes, then were they able to get it treated.

I think fat grafting might be the only option for me, but I have heard a lot of negative things about it. So I wanted to know from someone knowledgeable first hand.

Thanks

Grafting means the tissue is moved without a blood supply from one part of the body to another. A Flap, means moving tissue with a blood supply. I have demonstrated many examples of my Fat Flaps power to fill a void. There are limitations, too much removed and not enough local resources can mean a compromised result or a "bridge too far."  Check my Revision Gynecomastia and Chest Surgery pages for these examples.

I do not offer fat grafting. I do not like how the results look on animation. Since I do not offer the operation, that is why it is not featured on my website. However, I have seen many many unhappy patients from other doctors with fat grafts on their chests from other surgeons.  The problem is getting pictures / movies of patients who have come to me with such disasters. Someone comes into my office and I do not have something to offer: oh lets grab the camera so we can show your disaster to the world!  Instead of making that patient feel bad, I prefer to accentuate the positives helping them as much as I can.

You may have also seen some patients with fat grafts moving. Lips filled with fat grafts can have an animation problem.  When you see someone with filled out lips that seem rubbery and not moving well, that is something of a horror show in my opinion.  But then some will paralyze their face with botox and seem happy with the lack of animation!  (Something also that I do not offer.)  You may have noticed that those pushing their botox "solutions" also do not show how tissues move before after.  

Since I am not "selling" fat grafts, the proof that it works should come from someone who claims that it does.  Yet someday I may just go ahead and post one of these disasters that comes to me that I revise.

Be careful of someone claiming that their fat graft surgery works for the male chest contour deformity, check documentation of before / after.
You will want to see what happens as the areola muscle relaxes, is there still a good contour.  Bad contour problems can easily be hidden with a cold room or areola muscle stimulation.. A filled out profile can look better on a few photographs that may not be the case from other views.  Try to find at least a Set of Standard after Gynecomastia Surgery Pictures that shows what the results looks like with the arms up over the head and flexing muscles. The quality of the results may also not sufficient with how tissues move in animation. When I see Before and After Gynecomastia Revision Videos or Movies or a patient in person that shows improvement, then I will reconsider my opinion.  However, that will be one case in contrast to the many disasters I have already seen over the years.

Hope this helps,

Michael Bermant, MD

[decimal]

Thank you for your reply, Dr Bermant. I understand what you are saying. However, if I have absolutely no fat left on my chest, and easily feel the bony structure underneath, then it would mean that a fat flap is not an option for me. In such a case, can you offer a viable alternative?

[DrBermant]

Thank you for your reply, Dr Bermant. I understand what you are saying. However, if I have absolutely no fat left on my chest, and easily feel the bony structure underneath, then it would mean that a fat flap is not an option for me. In such a case, can you offer a viable alternative?

For most there are resources. For some they are depleted and do not have reasonable options I am aware of.  We help patients explore such concerns during their consultations or our Preliminary Remote Discussion.

Hope this helps,

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

[decimal]

For most there are resources. For some they are depleted and do not have reasonable options I am aware of.  We help patients explore such concerns during their consultations or our Preliminary Remote Discussion.

Hope this helps,

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

Does my present weight make a difference in the amount of available resources for reconstruction?  For example, I am currently 15lbs greater than my ideal weight. Would it make a difference if I went in for a revision fat flap surgery now as compared to after losing this excess weight? I was my ideal weight at the time of my last surgery.

Basically, my understanding is that losing and gaining weight only changes the size on the fat cells, and not their numbers. So when you say resources for reconstruction, are you implying size of the fat cells or the number of fat cells?

Thank you.

[DrBermant]

For most there are resources. For some they are depleted and do not have reasonable options I am aware of.  We help patients explore such concerns during their consultations or our Preliminary Remote Discussion.

Hope this helps,

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

Does my present weight make a difference in the amount of available resources for reconstruction?  For example, I am currently 15lbs greater than my ideal weight. Would it make a difference if I went in for a revision fat flap surgery now as compared to after losing this excess weight? I was my ideal weight at the time of my last surgery.

Basically, my understanding is that losing and gaining weight only changes the size on the fat cells, and not their numbers. So when you say resources for reconstruction, are you implying size of the fat cells or the number of fat cells?

Thank you.

Sometimes weight loss is better, sometimes losing weight removes resources needed for revision. I prefer to answer such questions after learning more specifics about a particular patient's situation. This in my hands is done during a consultation or preliminary discussion. If interested in learning more, Jane is my office manager.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.

Hope this helps,

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

[sabercut]

I did do a transfer to both sides. The right side stayed. It does move, and look quite normal or atleast thats what I feel. Some touch up might be required ex. a little lipo on the sides. Much depends on how fat is extracted.

For the left side, I didnt have that much luck, most of transplanted fat disappeared. 

All I will say is that this procedure is extremly unpredictable and a risk. Once again its better to avoid a situation like this.

As for weight, I have been in similar situation as well. I did fly over to Dr. Bermant's office, and he couldnt help me. So fat transplant was the last resort really. However, I was extremly thin then, 40 lbs less. Now that I have gained weight, I might have some resources. I am planning to visit him once again soon and see if he could help me with fat flap on the left side.

The only thing that I cant tell you - how will I look once I look weight. No data on that for the time being.

Best of luck.

[decimal]

Thanks for your response saber.

What caused you to require a fat transplant in the first place? Who was your doctor and what technique did he use? Was it a long operation, and was there any impact on the donor site?

Would you have any pictures you could share?  I m very anxious about this procedure.

Thanks
Anand

[DrBermant]

I did do a transfer to both sides. The right side stayed. It does move, and look quite normal or atleast thats what I feel. Some touch up might be required ex. a little lipo on the sides. Much depends on how fat is extracted.

For the left side, I didnt have that much luck, most of transplanted fat disappeared. 

All I will say is that this procedure is extremly unpredictable and a risk. Once again its better to avoid a situation like this.

As for weight, I have been in similar situation as well. I did fly over to Dr. Bermant's office, and he couldnt help me. So fat transplant was the last resort really. However, I was extremly thin then, 40 lbs less. Now that I have gained weight, I might have some resources. I am planning to visit him once again soon and see if he could help me with fat flap on the left side.

The only thing that I cant tell you - how will I look once I look weight. No data on that for the time being.

Best of luck.

Still to date I have yet to see even one successful fat transplant work for a gynecomastia defect that moved well on flexing muscles and lifting arms up overhead. Using the standard links posted above for photos and even better the standard videos can help others understand your success with this surgery.

40 pounds of extra tissue is a major change from when you were in the office. If that is fat, that may not be healthy. If it is muscle, then awesome!  I normally recommend my patients get to a weight they are happy with before surgery since weight loss before is much better than weight loss after. An exception is the many patients who have traveled to me for crater deformities from other doctors' misadventures. For these patients, they get the discussion that the weight loss can rob resources that might be of value in rebuilding a chest. However, I do not recommend adding the fat weight just for surgery as the extra fat is not healthy to live with. I have seen patients who were not candidates for revision develop resources with the weight gain just as I have seen patients who had resources loose them with weight loss.

The next issue will be how will these fat grafts act with weight loss. Since the resultant contour fill is fat that has partially died and scarred, just how these patients will end up after weight loss or gain is just not very predictable. Scar tissue will not shrink like fat does during weight loss and can become more prominent. Just as in the gland of gynecomastia, reduce the global fat and remaining gland (or in this case scar / firm fat) can become much more visible. Some of the really bad craters, when the skin is stuck to the muscle, weight gain actually increases the crater wall fat making the depth even worse. But now some of those patients now have resources to rebuild the problem. Other defects are so extensive, that the fat gain is just too far away to be moved with local blood supply.

Back to the success of the operation, I do not think an operation that still needs a "touch up" on the good side and fails on the other is something reliable enough to add to my tools. If further "touch ups" are needed as weight gets lost, that is again just another variable. Yet if it makes someone happy, then awesome. Compromise surgery sometimes is an option, but someone going into it should understand the limitations before the surgery. 

Video documentation of the degree of success on tissue movement could help others understand their options.

Congratulations on your progress and your happiness.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[tonysoprano]

Dr. Bermant - I've noticed that you always talk about *arms above the head and *pecs flexed in reference to movements during which a person's gyne situation might be expected to look 'at it's worst'. 

Now this seems weird to me, as someone 5 years post-op - gland excision+lipo ( who is definitely needing and currently planning a near-future revision), because for me - raising my arms and flexing my pecs are the positions in which my gyne is most minimized, and looks most flattering ()

When my chest is just relaxed,unflexed,with arms hanging at my sides (especially if I'm hunching forward a little) is when my chest looks at it's worst, with my nipples being at their puffiest and pointiest in this position...

Seems to be quite the opposite of the "least flattering positions" anecdotes we're usually hearing of, as both arms raised and pecs flexed are when my pointy,puffy nips WILL actually contract a lot, thus making these the most flattering positions for me..

just thought this was weird in terms of how it compares to these 2 most common "least flattering" chest situations you're so often referring to...

[Dr. Elliot Jacobs]

The male chest is usually viewed with one's arms at one's side -- such as when walking on a beach.  When the arms are raised over the head or the muscles tensed, there can be distortions seen.  Lax skin or hunching over can further exacerbate the look of gyne.

That is why standard photos and poses are needed in evaluating a patient before and after surgery.

Dr Jacobs

[DrBermant]

Dr. Bermant - I've noticed that you always talk about *arms above the head and *pecs flexed in reference to movements during which a person's gyne situation might be expected to look 'at it's worst'. 

I have never said such views showed the chest "at it's worst."  Flexing views and arms up over head show critical components of how the body looks while living life, playing sports, having fun. Even walking at the beach, we do not go around with our arms rigidly at our sides. I work with many bodybuilders. Many complained about results they had from other surgeons looking terrible during competition or just while enjoying their body in motion. That is why I evolved several different sets of standard pictures for gynecomastia. The original set had one arms up overhead, and arms on hips muscles relaxed and then flexed.  The set for after gynecomastia surgery for revision expanded the flexing views to include obliques and laterals relaxed and flexing. Some of the adhesion and craters better show up (results look worse with problems) when adding the additional flexing views. The videos are the most critical of the recording media short of seeing the results live. The ultimate is to look good in person living life, moving about without the emotional stress of distorted tissues.

Since we see so many patients from around the world, I needed a way to help them demonstrate their problems and minimize travel to Virginia. When I can define the problem before travel, we can schedule our patients for a tentitive surgery that still requires the confirmatory in office exam. These standard sets have been incredibly valuable for the vast majority of our patients minimizing travel.

Beyond that, I found that such documentation was better at defining the deformity and quality of the sculpture.
When evaluating before and after pictures that only include relaxed front and oblique views, you are only seeing part of the picture. The chest should look good in the entire set of standard views and even better on videos. This is critical in understanding problems and the quality of surgery offered. When the surgery looks good in all of these views and video, then you are really talking about a better sculpture than one that only looks good with muscles relaxed or arms at the sides.

Now this seems weird to me, as someone 5 years post-op - gland excision+lipo ( who is definitely needing and currently planning a near-future revision), because for me - raising my arms and flexing my pecs are the positions in which my gyne is most minimized, and looks most flattering ()

When my chest is just relaxed,unflexed,with arms hanging at my sides (especially if I'm hunching forward a little) is when my chest looks at it's worst, with my nipples being at their puffiest and pointiest in this position...

Seems to be quite the opposite of the "least flattering positions" anecdotes we're usually hearing of, as both arms raised and pecs flexed are when my pointy,puffy nips WILL actually contract a lot, thus making these the most flattering positions for me..

just thought this was weird in terms of how it compares to these 2 most common "least flattering" chest situations you're so often referring to...

I have a third set of standard views that evolved to show issues of loose skin. When arms are brought overhead, or shoulders brought back, skin is tightened. For these patients, bending over, letting gravity pull the excess proved to be the most reliable method to show this problem. Loose tissues is the most difficult distortion to document well without the hands on examination. Check the male mastopexy section to see those views in action in defining the problem, the compromises and results achieved. For the more subtle forms of loose skin issues, the arms up overhead look better. For the individual with scar adhesion and loose skin, the arms up overhead can sometimes show both components.

We help patients explore their options during consultations and my Preliminary Remote Discussion. We guide our patients which set of views will best serve efforts to minimize travel to Virginia. When images alone do not suffice, then the in office exam is needed before tentative surgery can be scheduled.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[jusken]

I think Bermant's fat flap technique sounds pretty good.

But, for anyone with less resources (like me possibly), I might look into Stem Cell Fat Transfers.  I'd like to know more about whether this would be ideal for a male revision surgery.  It is said that new blood vessels form using this procedure, and that a vast majority (80-90%) of the fat survives.

The only remaining concern is whether some of the fat calclifies afterward, which would look bad on animation.

It seems promising anyway.