Crater Deformity ?

[Hope_Forever]

I underwent gynecomastia surgery by Dr.Anantheshwar, Manipal Hospital, Bangalore in June 2011. I think I have got crater deformity as a result. Could the learned doctors please review the pics and advise me. Will fat grafting help ?

flickr.com/photos/85432243@N08/

[Dr. Elliot Jacobs]

It appears that your weight has fluctuated significantly from your original pre-op, to the post op (when you seemed to have lost a lot of weight) to your present condition (when you seem to have put weight back on again).

Actually, your immediate post op photos look reasonably good.  And it doesn't appear that any skin was excised -- which serves as proof as to the ability of skin to tighten by itself if given the opportunity.

Would strongly advise you to lose weight back to your immediate post op state -- and then re-visit your surgeon to see if anything can be done with residual carters.  Oftentimes, either fat grafts or fat flaps can be useful.

Dr Jacobs

[Hope_Forever]

Hello Dr Jacobs, I didn't realize I had lost weight at that time. My drains were removed after 2 weeks of the operation. During that time I hardly ate anything nor could sleep well which could be the reason of the weight loss. My surgeon said that he can suction the residual fat from the surrounding area right below the armpits and can give fat injections under the nipples. I requested him to do liposuction to my tummy as well which he is refusing to do. He is asking me to reduce my tummy by working out. I am getting frustrated because my tummy fat is very adamant and refuses to go away. I am looking for a doctor who can do all these things together.

Doctor, please can you explain the difference between fat grafts and fat flaps? Also, advise me if it's risky to do liposuction of stomach, flanks, under armpits and fat injections on the same day?

[Litlriki]

I would agree with Dr. Jacobs assessment that your result is better at a lower weight.  In any case, correction with peripheral liposuction and central fat grafting would be a reasonable approach to take.  Using fat flaps as opposed to fat grafting would be slightly more invasive, since this would require reopening your peri-areolar incision, but this would also be reasonable.  Fat flaps involve opening the incision and using fatty tissue from around the central depressed area to fill in the depression by mobilizing and suturing them.  Fat grafting uses fat removed with liposuction and re-injected into the central depressed area.

Regarding liposuction of the abdomen versus DIET and exercise...The results of liposuction would not be particularly satisfying to you, since liposuction will only remove fat between the skin and underlying muscle.  Your abdomen looks to be pretty big and round from the photo, meaning that you have fat on the inside as well as the outside, and the internal or "visceral" fat doesn't go away with liposuction--only with DIET and exercise.  Removing the superficial fat will still leave you with a big round belly--it will just have less fat on the outside. 

Exercise alone will not alleviate the weight issue without making dietary adjustments, at least not very quickly.  Imagine that it takes a 6 mile run to burn off one piece of chocolate cake--so how much exercise alone would it take to burn through what you eat on a daily basis?  Quite a lot.  You should focus on your caloric intake, such that what you eat daily falls slightly short of your caloric needs.  Adding exercise allows you to take in more calories, but you would still need to be in a "caloric deficit"--in other words, you need to be using more calories than you're consuming.  Other maneuvers to help lose weight are to divide your meals into smaller meals every 3 to 4 hours, rather than 2 or 3 large meals each day.  Also, writing down what you eat is very effective to help with weight loss.  The highly guarded secret to weight loss is simple math: what goes in has to be less than what comes out!  Even the most adamant fat cannot beat the simple rules of arithmetic.  If you have an iPhone or similar device, look for an app called "Lose it" or something similar, which monitors caloric intake and works great for calculating what you eat over the course of the day.

Good luck,

Rick Silverman

[Hope_Forever]

Dr. Silverman, Really appreciate your detailed response and the valuable "tips". Though in theory, even I know what has to be done. But "practically" implementing it is most challenging to me. I have been trying that for a long time without much success. I always get beaten by my hunger and desire for "tasty" food. But I am going to keep trying and see what happens. I have almost made up my mind to atleast get the superficial fat removed by lipo and also correct the crater with fat grafts.Thank you.

[Dr. Elliot Jacobs]

What Dr. Silverman alluded to is a change in the way you eat -- it is a "take charge of your life" kind of strategy.  If you always give in to your hunger you will never lose the weight and you must be content with your body.  Losing weight it difficult -- but the math is simple:  less calories in and more calories out (in the form of exercise, more muscle mass, etc).

Good luck!

Dr JAcobs

[Hope_Forever]

Doc, but why do some guys eat the same as me, don't do any physical activity different than mine but still stay slim/fit? I can say that because they are my friends or colleagues and I do observe what they are doing in day and what they are eating. I don't get that.

[Dr. Elliot Jacobs]

Ah, the eternal question.  And one, for which, medicine has no answer at present.

Dr Jacobs

[Hope_Forever]