Fat Transfer needed for Crater Deformity after gyne op 3+ years ago

[Vol-au-vent]

Hello Doctors,
I would be very grateful to receive feedback on my situation:

I've had (mostly) successful bilateral gynecomastia surgery 3 years ago with full excision of breast tissues and liposuction to my breasts. A month after surgery it became apparent that I had a noticeable depression in my left breast and a minor depression under my right nipple.

See attached pictures.

I believe this was caused by the large size of the breast tissues removed and possible over liposuctioning. I have been offered the opportunity to return to the original surgery clinic and have a fat transfer procedure done. It is proposed I have fat liposuctioned from a part of my body and injected into the depressed areas.

My question today is:
Would injecting fat freely like this into the depressed cavities (where my glands were) be the best solution? Most importantly, do you think the injected fat will either by absorbed by my body and disperse to other places or would the fat droop down from the middle of my breast and collect down in the bottom of my breast which would be cosmetically undesirable?

I have lost lots of weight this year in preparation for revision surgery but I expect I'll need to loose another 10 pounds after surgery and I'm curious to know if this freely injected fat runs a higher risk of burning off when I loose the weight just because of how it's been put (freely) into my body.  I would hate to have the surgery, loose 10 pounds and have all that injected fat disappear, returning me to where I was pre revision.

I would greatly appreciate your professional insight, assurance or alternative recommendations on this matter.

Many thanks doctors!

[Dr. Elliot Jacobs]

You have significant crater deformities.  There are two possible treatment alternatives:  fat grafting or fat flaps.  I prefer the latter.

Fat grafting can work but there are many pros and cons concerning the procedure.  Best to speak with your surgeon about these.

Good luck!

Dr Jacobs

[Vol-au-vent]

Thanks for your reply Dr Jacobs. The surgeon who has offered me this revision surgery only does fat grafting/transfer, not fat flaps. So for the moment I am pursing the former option. I was hoping I could get some external opinion from surgeons other than my current one.

I understand from reading previous posts that there will be a large amount of injected fat that will die and not take to the injected site, so over-correction of the site will be required. But of the fat that takes I would like to know if:


-It is likely that injected fat will droop downwards and move away from the target area.


-And if I loose weight (10lbs/5kgs) is the injected fat more vulnerable to being metabolised first over other fat in my body?


-I read here that scar tissue from dead fat cells can form but eventually it can go away right?


-and ultimately, are the 'cons' Dr Jacobs indicated so significant and permanent enough that I could end up making a mess of my chest more than it is? 

Many thanks.

[DrPensler]

Correction of secondary deformities are easy to describe as a general rule but much harder to execute in practice. Absorption after grafting is a best unpredictable in a scared bed.I do not mean to imply that its not a good option but rather that its not a slam dunk so to speak.

[Vol-au-vent]

I'm sorry but these vague responses don't really help me. I appreciate it's difficult to predict for any one person but some general advice based on your clinical experiences with patients or addressing my questions specifically would be very welcome.
Anyway, it's most likely that I will go ahead with the fat transfer procedure as it's been offered to me by my surgeon free of charge. I suppose the one thing that I am most worried about is causing irreparable cosmetic damage to the treatment area through fat injection. ie permanent scaring by dead fat sells etc. Could this really happen? 

[Dr. Elliot Jacobs]

Fat grafting works -- but an in-depth answer to your questions would require a book. Every patient is different and every surgeon's skill set is different.  In essence there are a huge number of variables that will impact the results of any fat grafting treatment.

Again, would strongly advise you to speak in depth with your surgeon prior to his fat grafting -- and ask him all the tough questions.  In particular, you should discuss all the pros and cons of the procedure and what you might expect under the best and the worst of results.

Dr Jacobs

[Dr. Schuster]

I agree with the other doc's comments. I would predict that you would require more than one session of fat grafting to be successful.