Fat Transfer Procedure - has anybody had this done?

[kayvee]

(semi-crossposted to my main thread)

Heyo, as I mentioned in my diary post, I'm going to probably be having a little bit of revision surgery when I get back to the UK.

Specifically, part of the procedure will probably involve a fat transfer/graft procedure into an area just underneath the mectoral muscle curve. What seems to have been done, is that more fat has been liposuctioned (or disappeared during the healing process) under my right pec. I have very little fat on my chest in the first place, so even though it's not a major divot it still looks slightly odd.

Dr. Levick basically said they'd be doing an what I gather to be an ordinary fat transfer procedure: removing fat from one area of the body and injecting/layering it into the area to be filled out.

I asked about the survivablility rate of the fat having heard from various places that fat transfer procedures were a) not permanent (lips, Dr. Levick explained that this was due to the comparatively very high level of mobility in the lips), and b) have a tendency to go hard or move unnaturally (though to be honest, the divot is in an area that doesn't move with the muscle, so I'm not too worried about that ... also I'm athletically very active, so I'll be moving the tissues about manually after surgery to make sure they don't set evilly).

The other part of the revision surgery is actually removing a little more fat from over the other side of that pectoral, and I get the impression that the presence of the excess is making the divot seem worse ... it's lying from above the top to over the bottom of the pectoral curve, for example, so when I tense it doesn't move.

Anyrate, my main question concerning the fat transfer procedure, is:

Has anyone had this procedure done as part of their revision surgery? If so, how did it go, do you have any pictures that could illustrate it, and what were your overall impressions?

Obviously, according to people such as Dr. Bermant, they're not necessarily very successful, so I'm wondering whether people have any first hand experience with this.

My original posts can be found at: http://www.gynecomastia.org/smf/index.php/topic,5988.0.html

Thanks in advance.

[DrBermant]

(semi-crossposted to my main thread)

Heyo, as I mentioned in my diary post, I'm going to probably be having a little bit of revision surgery when I get back to the UK.

Specifically, part of the procedure will probably involve a fat transfer/graft procedure into an area just underneath the mectoral muscle curve. What seems to have been done, is that more fat has been liposuctioned (or disappeared during the healing process) under my right pec. I have very little fat on my chest in the first place, so even though it's not a major divot it still looks slightly odd.

Dr. Levick basically said they'd be doing an what I gather to be an ordinary fat transfer procedure: removing fat from one area of the body and injecting/layering it into the area to be filled out.

I asked about the survivablility rate of the fat having heard from various places that fat transfer procedures were a) not permanent (lips, Dr. Levick explained that this was due to the comparatively very high level of mobility in the lips), and b) have a tendency to go hard or move unnaturally (though to be honest, the divot is in an area that doesn't move with the muscle, so I'm not too worried about that ... also I'm athletically very active, so I'll be moving the tissues about manually after surgery to make sure they don't set evilly).

The other part of the revision surgery is actually removing a little more fat from over the other side of that pectoral, and I get the impression that the presence of the excess is making the divot seem worse ... it's lying from above the top to over the bottom of the pectoral curve, for example, so when I tense it doesn't move.

Anyrate, my main question concerning the fat transfer procedure, is:

Has anyone had this procedure done as part of their revision surgery? If so, how did it go, do you have any pictures that could illustrate it, and what were your overall impressions?

Obviously, according to people such as Dr. Bermant, they're not necessarily very successful, so I'm wondering whether people have any first hand experience with this.

My original posts can be found at: http://www.gynecomastia.org/smf/index.php/topic,5988.0.html

Thanks in advance.

Fat grafts tend to die or become firm, smaller. The results often look terrible especially in motion.  Watch a chest with fat grafts move, the firm tissue of gynecomastia has often been replaced by surgical scar tissue.  That is why I show dynamic views on my website.

I prefer my Dynamic Technique for my Revision Gynecomastia Surgery where, what I find during surgery helps guide what needs to be done.

When gland and scar tissue are present, and they usually are, I prefer to start with and target this firm gland and scar first. By concentrating on the gland and scar, I target the tissue that compresses the least and reserve the remaining fat as a potential tool for my reconstruction. 

Liposuction is fine for fat.  However, all forms of liposuction preferentially remove fat over gland.  When fingers of fat are between fingers of gland, liposuction alone tends to suck out the fat condensing  the gland behind making a mess. 

Liposuction is but one of many tools of my artist's palette for surgical sculpture of the male chest and gynecomastia.

• Excision,
• Liposuction,
• Microliposuction,
• Nipple Sculpture,
• Mastopexy Male Chest Lift,
• Skin Reduction,
• and other techniques.

My Fat Flaps can bring fat into a crater.  A flap is tissue moved with a blood supply.  Adjacent fat transfered with a blood supply tends to survive, much better than a graft.  When carefully done, fat flaps tend to look like normal fat, feel like normal fat, and move like normal fat.  There are limitations to what fat flaps offer since fat still connected to its blood vessels will move only so far.

Try to go through the entire section about male chest sculpture on my site to learn what my techniques of surgery have to offer.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[kayvee]

Watch a chest with fat grafts move ...

Would you be able to provide this? I can't actually see a single case of fat graft related photos or movies on your website, sorry if I'm being blind.

Honestly, thank you for your reply, but it doesn't actually seem to apply remotely to my situation. I understand that you provide general information on/from your website (and obviously as professional charge real money for your time and services), but for someone trying to find out the ins-and-outs of a potential revision procedure, recommended by an experienced surgeon, this overall is just very confusing.

For example, sites such as:

http://www.plasticsurgeryproductsonline.com/issues/articles/2005-06_08.asp

http://www.daikanyama-clinic.jp/Mega%20Liposuction%20-2%20%20English%20.htm
http://www.daikanyama-clinic.jp/Mega%20Liposuction%20-3%20%20English%20.htm
(^ pages 2 and 3 of the same article)

... give considerably more information about, and a much more positive outlook on, fat grafting than any of the sources I have come across that describe the failure rates as prohibitively high or the results as looking unnatural.

As far as gland goes, re: the liposuction bit, the liposuction would be from an area of my chest where there either isn't gland any more, or wasn't any gland in the first place (along the underside line of my pectoral muscle). If the graft was going to lie on top of a muscle, I would be able to understand the problem with movement, but the area in which the fat is to be grafted actually forms part of a natural contour, and doesn't need to be filled out completely ... it just looks "toned", I suppose there may be some tethering there, but I've seen pictures of people who haven't had surgery with far more pronounced "clefts", even in a desirable way.

Would you be able to provide resources or more specific information about the risks of fat grafts "hardening", as the only descriptions of it I seem to be able to find refer to calcification (being a reason it's not advised in breast enlargement ... bizarrely, the main reason it would be in the first place is that it feels more natural than silicone)? Honestly to me it seems like it's a question of technique, as opposed to the inherent impracticality and unadvisableness of the procedure itself.

And again, if anybody has HAD this procedure done, and has photos, videos, testimonials, whatever, could you please throw me a few words? Am sort of running into dead ends and what I worry is advertising, as opposed to analysis, on cosmetic surgery websites.

[freefromG]

Hey Kayvee, did you end up having this done...?

[Dr. Elliot Jacobs]

Let me provide some info about fat grafting. 

It is an accepted procedure by all plastic surgeons.  It is also very technique dependent.  There are many variables as to how it is collected, treated, injected, etc.  But it does work.

I have used fat grafting in patients from other surgeons who were either uneven or had too much fat or gland removed.  And it has worked.

However, as in all techniques, there are precautions.  Sometimes not all of the transferred fat will live.  Then it becomes firm as it is replaced with scar tissue.  Fat must be grafted in thin lines -- surrounded by normal tissue so that it will gain new blood supply from the surrounding areas.  If too much fat is injected at one time, then not all of it will gain a new blood supply -- this is the cause of some treatment failures.

I always caution my fat graft patients that it may take more than one procedure to produce the desired result.

DR Jacobs

[DrBermant]

Watch a chest with fat grafts move ...

Would you be able to provide this? I can't actually see a single case of fat graft related photos or movies on your website, sorry if I'm being blind.

I do not offer fat grafting. I do not like how the results look on animation. Since I do not offer the operation, that is why it is not featured on my website. However, I have seen many many unhappy patients from other doctors with fat grafts on their chests from other surgeons.  The problem is getting pictures / movies of patients who have come to me with such disasters. Someone comes into my office and I do not have something to offer: oh lets grab the camera so we can show your disaster to the world!  Instead of making that patient feel bad, I prefer to accentuate the positives helping them as much as I can.

You may have also seen some patients with fat grafts moving. Lips filled with fat grafts can have an animation problem.  When you see someone with filled out lips that seem rubbery and not moving well, that is something of a horror show in my opinion.  But then some will paralyze their face with botox and seem happy with the lack of animation!  (Something also that I do not offer.)  You may have noticed that those pushing their botox "solutions" also do not show how tissues move before after. 

Since I am not "selling" this operation, the proof that it works should come from someone who claims that it does.    Yet someday I may just go ahead and post one of these disasters that comes to me that I revise.

Be careful of someone claiming that their fat graft surgery works, check documentation of before / after.
You will want to see what happens as the areola muscle relaxes, is there still a good contour.  Bad contour problems can easily be hidden with a cold room or areola muscle stimulation.. A filled out profile can look better on a few photographs that may not be the case from other views.  Try to find at least a Set of Standard after Gynecomastia Surgery Pictures that shows what the results looks like with the arms up over the head and flexing muscles. The quality of the results may also not sufficient with how tissues move in animation. When I see Before and After Gynecomastia Revision Videos or Movies or a patient in person that shows improvement, then I will reconsider my opinion.  However, that will be one case in contrast to the many disasters I have already seen over the years.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery