Craters when flexing 3mo Post OP

[nf87]

I'm just a bit over 3mo out from surgery. It was for mostly puffy nipples, the amount of gland wasn't that much. Note my left nipple has always sat at a little different angle. My procedure was VASERLipo only. We were clear upfront that I wanted excision if needed whatsoever, but I guess he didn't think so.  

I've had 2 rounds of kenelog injections as the surgeon though I was developing scar tissue. The lumps under my nipple responded and reduced in size. I still have little "nuggets" under the nipple, but not too worried about that. 

I've  put on about 8lbs since surgery (call it 50/50 fat/muscle). This is by design as I'm in a slight surplus for lifting right now and I'll eventually get leaner than I was at surgery. I do think this contributes to the appearance of the craters (when flexing or raising arm). I can tell there is a little more fat around the area (but not nipple).  

I'm happy with the way they look at rest, but not as much when flexing. I've read this specific scenario may be caused by scar tissue tethering the areola to muscle? I have an appointment with my surgeon on Monday, I'm going to refuse anymore shots or whatever at the moment, but get his thoughts on these craters. 

What are the realistic chances these fix themselves after ~3mo post-op? 
More kenelog is a definite no right? 
Is the best option down the road most likely a fat graft/flap if I chose revision?
Am I being overly picky? 
I know if I do have a revision it would be with an expert in gyno revision and craters. Michael Law out of Raleigh, NC seems like a good fit. I live in the south. 

I appreciate any thoughts and advice! Thank you

[nf87]

One relevant thing I just noticed...

When I pinch the "nugget" (what is believed to be scar tissue(?)) and pull it out, then contract my pec, the muscle pulls it in strongly through my pinch--like it is tethered. This is only on the left side. On the right when I do this the muscle is not tugging the "nugget" forcefully and I am able to keep it pinched. This is consistent with the left crater being more significant than the right, upon flexing. Note pics to demonstrate what I'm referring to.

[Litlriki]

Crater deformities are typically the result of over-resection of the subareolar tissue without adequate contouring of the adjacent tissues.  It would be less common with liposuction only unless over-resection occurred during the liposuction procedure.  It sounds more like you're dealing with scar tissue adherence, which ideally you could break up with massage and time, but might require surgical intervention if it's not loosening up with other means. I wouldn't recommend more injections. 

[Dr. Schuster]

I'd hesitate before any more steroid injections if you already feel that there is an indentation. You might still be able to improve any retraction by continuing to pinch and pull the nipple outward. Good luck.

[Dr. Elliot Jacobs]

Yes, you have a crater on the left side, which is usually due to excess removal of supporting tissue just beneath the areola.  And if there is a crater, cortisone will not help. and in fact could be counter productive.  I have never seen a true crater improve with massage -- the problem is anatomic -- there simply is not enough tissue under the nipple and massage will not add more tissue.

In dealing with craters, my go-to procedure is to use fat flaps with or without additional precise liposuction on the surrounding areas if needed.  Fat grafts are useful for small contour irregularities but not my first line treatment approach for craters.

Dr Jacobs

[Dr. Schuster]

I agree with Dr. Jacobs and didn't mean to insinuate that massage can correct crater deformities. Three months post op is still a little on the early side to do any surgical revision. There is no harm in tryinf to stretch any existing scar tissue with massage and stretching. If a crated deformity continues after another three months you will need surgical reviion.