Revision?

[mademan]

Hello I had Gyno surgery done last year and would like opinion or advice from any doctor.

I had bilateral surgery done on my chest last May with gland and liposuction . After the procedure my doctor asked me what my opinions were and I always mentioned that I am happy that I went with the surgery as I notice a huge difference from what I had before, however,  my only comments are on the amount of fat that was removed . Specifically below the nipple and around the side of the chest towards my underarm. Recently I went back for a check up and I mentioned the same concern and this time he asked if I would be interested in doing a revision under local anesthesia to remove some of the extra fat left.

My question is , how much would be improved if I went ahead with a revision? and would it compromise or possibly make the whole outlook of my chest worse? possibly form cratering or inverted nipples?

I have below pictures to show before and after.
BEFORE






AFTER (2 months Post-op)



As you will note in this picture below there is puffiness below the nipple and around the side to my underarm





SEP 12 2017








Under shade the area of interest is seen better where it is obvious there is either still more fat or scar tissue visible under the nipple and underarm area

[Dr. Elliot Jacobs]

Overall, a good result, but there still seems to be slight residual tissue in the areas you mentioned.  Whether to proceed with revision surgery to remove that residual tissue is obviously your choice.

Good luck!

Dr Jacobs

[DrPensler]

It appears that you have some retained tissue most likely fat in the areas you mentioned. Liposuction in instances like this are effective generally. The key issue is there should be adequate tumescent solution used and enough analgesia to allow adequate removal of the retained tissue.

[mademan]

Thank you Dr. Elliot Jacobs and Dr. Pensler

I have posted better images to show .
I am seeing my doctor next Friday Sep 29, are there any other concerns I can bring up?
Also how much improvement would a revision make?
My doctor has said he would reopen the same incisions from before , they are currently fading away nicely would that make them more visible in the future?

[Dr. Elliot Jacobs]

These are much better photos and indeed do reveal the craters and residual tissue on both sides.

If your surgeon goes back through the same incisions (which would be the wise move), they should heal just as well as the original incisions and they, too, will fade in time.

Good luck!

Dr Jacobs 

[Dr. Schuster]

The last set of photos seem to show a larger area than can be seen in the previous photos. Liposuction, and if possible ultrasonic liposuction will probably make an improvement. However I would also suggest trying to lower the inframammary crease which might allow some of the redundant skin to slide downward just a bit. Any little bit would help. Also, if you wear a vest aferward, it would be important to try to elevate the nipple area, and certainly avoid pushing them down. All of this is to try to get the skin to shrink in all directions. Good luck.

[George Pope, M.D.]

I would like to add one suggestion.  Given the large area that needs additional treatment, you may want to consider general anesthesia or IV sedation rather than local.  If you have a low pain tolerance, your surgeon may be limited here.  Often the scar tissue that builds up after surgery makes performing additional liposuction a little painful under local.
Talk to your surgeon about this; it would be fair to ask him if he can do a better revision job with you asleep.
Best of luck-
Dr. Pope, MD

[DrPensler]

You would benefit from a revision. I totally agree with the suggestion for adequate sedation.

[Litlriki]

I would also agree with a revision with liposuction in both of the areas noted.  Sedation would certainly be a nice option, but if price is an issue, your doctor can give you some oral medications that will take the edge off of the discomfort and make the procedure a little more tolerable.  

[mademan]

Thanks everyone! I did the revision yesterday , It was a lot more uncomfortable than I expected . The doctor said he removed about 100cc all together 50 on each side.

I know its very early to tell but I am noticing a small fat flap underneath the right nipple, Is this a sign it may linger in the coming months? If in a year it doesn't get better what are the procedures to correct it?

after this surgery I hope to move on with my life and forget about it .

[Dr. Elliot Jacobs]

Sorry you had discomfort -- surgery should not mean that you should suffer pain.  Most likely it was done under local anesthesia.  And local anesthesia in secondary cases is not as successful -- general or IV sedation is much preferred.

As for worrying about results, why don't you give it some months to see what the results of the revision surgery will be?

Dr Jacobs

[Litlriki]

I would agree with Dr. Jacobs regarding some patience to see the results. 

[mademan]

I would like to thank everyone for their advice it really helped me decide whether to pursue a correction . At the current moment I don't see much of a difference, as expected it is too early . In the coming months,  I will continue to monitor the progress and post pictures in the new year

Thank You all!!

[mademan]

I wanted to give everyone a visual , I'm about 2 weeks in post-op revision.
Its still not perfect as I wanted , however I have accepted it and only hope through healing ,weight-loss, and weight training it will come out better. The truth is that under certain lighting the creases and indents are more visible but a day on the beach it is unnoticeable . I believe my doctor did a good job he broke apart the shape of what remained, but time will tell . It is a huge difference from the begging.

[Litlriki]

It's early to comment on the results, since swelling will obscure what was done at this early stage.  When I describe what I've done relative to volumes of fat removed, I often describe it in terms of "sticks of butter," since this gives patients a visual sense far greater than 50 cc or 100 cc might provide.  If you had 50 cc of fat removed from each side, that's about 1/2 stick of butter.  Imagine that fluffed up a bit and distributed on the chest in the areas addressed with the revision.  That amount should provide improvement, though possibly not 100%, but it would also be unlikely to leave any sort of crater resulting from over-resection.  Let us know how things are in about 6 months!