Fat Flaps vs. Fat Injected for Chest Sculpture

[DrBermant]

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 body 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 and Chest Surgery

[sabercut]

Thanks Dr. Bermant for your post.

Since your last post, there has been a certain positive development. Cytori's celution 700 which is used to enrich fat grafts with stem cells derived from stem cells has been granted FDA approval.

http://ir.cytoritx.com/releasedetail.cfm?ReleaseID=397308


I am sure it will still take time until we see some positive results, atleast this is a positive step.