Crater, sunkenness or inversion during healing - Dr. Bermant?

[blackberry]

For those of you that are 6 months out and currently do not suffer from any cratering, sunkenness OR inversion did you have any of those attributes in the time period post op to 6 months?

Dr. Bermant says his procedures and healing processes are such that his patients typically do not suffer from cratering, sunkenness OR inversion.  For those that have had surgery with Bermant is this true during the entire healing process? 

Is it common to have cratering, sunkenness OR inversion and then for it to go away by the end of the healing process?

Thanks for the info.

[DrBermant]

For those of you that are 6 months out and currently do not suffer from any cratering, sunkenness OR inversion did you have any of those attributes in the time period post op to 6 months?

Dr. Bermant says his procedures and healing processes are such that his patients typically do not suffer from cratering, sunkenness OR inversion.  For those that have had surgery with Bermant is this true during the entire healing process?  

Is it common to have cratering, sunkenness OR inversion and then for it to go away by the end of the healing process?

Thanks for the info.

Almost all of my patients move on with their lives, put their gynecomastia days behind them.  Some do stay on the forums a while to help others.  Many more do not post at all.

Crater Deformity Complication after Gynecomastia Surgery is better managed by prevention.  Sometime revision is possible.

A crater at the end of surgery is a major problem.  It will not go away.  Tissues do evolve to a degree, subtle contour issues tend to even out.  That is why picking an experienced surgeon is so important.

Hope this helps,

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

[blackberry]

What about crater or depression a few weeks after surgery after many people on these boards talk about?  Is that common or within the range of "normal" during the healing process?

Thanks again for the guidance.

[DrBermant]

What about crater or depression a few weeks after surgery after many people on these boards talk about?  Is that common or within the range of "normal" during the healing process?

Thanks again for the guidance.

Craters are not normal for my patients, but I have seen many such deformities from patients unhappy after surgery done by other doctors.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[Noseguard]

From my pre op screening of Doctors I astonishingly came across doctors who not only performed surgery with cratering as a result, but actually showed the photos as if they were proud of the results.

The first surgeon I went to was close to my home, very expensive, and completely incompetent to perform gynecomastia surgery.  His before and after photos routinely showed cratering.  When I asked about it he said it was "unavoidable", and "compared to the before a great improvement".  I recall leaving there thinking I would never look good with or without surgery.

The single greatest thing about this board is the sharing of experiences. If not those posts not sure I ever would have found a doc with the experience and ability to do it right. 

[superduty]

What is the cause of the sunkenness or crater?  Too much gland removed? Not enough?  Too much lipo?  Not enough?

[Noseguard]

I am not a doctor, but yes I believe most times it is the result of too much gland removed.

My doctor told me (if I can recall) that knowing how much to leave is the "art" of it.  I for one believe that is why you MUST do your research on the docs. There are great differences in quality and experience.  Cost seemed to vary but only due to geography.  Quality varies regardless of cost.

[DrBermant]

What is the cause of the sunkenness or crater?  Too much gland removed? Not enough?  Too much lipo?  Not enough?

Causes of crater deformities after gynecomastia surgery primarily are due to surgical technique, skill of the surgeon, scarring, but can also involve patient healing and other factors.  With my Fat Flap Technique, I am able to target gland first and then use near by fat to contour the chest.  Leaving gland behind can distort the chest on animation.  Gland does not move like fat.  Residual gland is a major cause of Puffy Nipple Deformity After Gynecomastia Surgery.

Yes, picking a surgeon with the right skills is very important. 

Hope this helps,

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

[chociii1980]

Is it pissible to fill the crater with muscle?

[trojan213]

Is it pissible to fill the crater with muscle?

I'm not a doctor, but that sounds incredibly unlikely. The pectoralis major and minor are pretty large with strands running across your chest. I don't see how you could "fill" in a small isolated spot. Fat/glad sit on top of your muscles.

[DrBermant]

Is it pissible to fill the crater with muscle?

A Crater Deformity Complication after gynecomastia surgery is a term I coined years ago to describe the terrible results I have seen from other doctors misadventures when the skin is adherent to the underlying muscle / areola.  The extend of the defect can vary from a subtle depression to no fat left at all.  It can vary in extent from just a surgically caused inverted nipple to involving the entire chest as shown in this example of bad scarring after over aggressive liposuction of the male chest.

The deformity is one of missing fat.  Replacing the missing tissue with muscle is not a good option.  It may look good on a still photograph, but in motion, it does not.  Take a look at the various movies I have posted on the craters.  To fix this deformity, the missing fat is best replaced with fat.  My fat flap contouring brings fat with a blood supply from adjacent regions to fill the defect.  Bringing a blood supply has a much better chance of keeping the fat cells alive. 

Fat transferred by grafting frequently dies, shrinks, or firms up.  I have seen so many complications from other doctors' fat grafting where the transferred fat was just as firm or firmer than typical gynecomastia gland.  Filling the defect with firm fat or scar tissue does not look good on animation, flexing the muscles, and moving the arms.  Now, I do not see possible successes that other doctors have done with fat grafting.  However, I have seen patients who other doctors have presented at meetings with supposedly good results (on still photos). Those who have been unhappy enough to come to see me, look horrible.

When the crater deformity involves the skin stuck down to the chest, fixing the problem by removing the crater walls and fixing those sections also to the chest wall is not a good option.  Check out that link to the example above on extensive liposuction deformity.  However taking out even more surrounding fat, the defect can look better at rest or in a still photo.  When the crater is only a relative deformity with no adherence and some fat under the nipple.  Crater wall liposuction is certainly an option.

The best way to deal with this problem is prevention.  Picking the right doctor for the surgery is very important.  I just saw a presentation at a meeting where the doctor proudly showed how "good" his gynecomastia surgery was and the after surgery pictures were craters at rest!!!

Hope this helps,

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

[superduty]

Dr. Bermant, the person shown on your www site - http://www.plasticsurgery4u.com/revision_gynecomastia/gynecomastia_bad_scar.html  Were you able to do revision on him?  If so, do you have any after pictures of that revision?

[chociii1980]

Is it pissible to fill the crater with muscle?

A Crater Deformity Complication after gynecomastia surgery is a term I coined years ago to describe the terrible results I have seen from other doctors misadventures when the skin is adherent to the underlying muscle / areola.  The extend of the defect can vary from a subtle depression to no fat left at all.  It can vary in extent from just a surgically caused inverted nipple to involving the entire chest as shown in this example of bad scarring after over aggressive liposuction of the male chest.

The deformity is one of missing fat.  Replacing the missing tissue with muscle is not a good option.  It may look good on a still photograph, but in motion, it does not.  Take a look at the various movies I have posted on the craters.  To fix this deformity, the missing fat is best replaced with fat.  My fat flap contouring brings fat with a blood supply from adjacent regions to fill the defect.  Bringing a blood supply has a much better chance of keeping the fat cells alive. 

Fat transferred by grafting frequently dies, shrinks, or firms up.  I have seen so many complications from other doctors' fat grafting where the transferred fat was just as firm or firmer than typical gynecomastia gland.  Filling the defect with firm fat or scar tissue does not look good on animation, flexing the muscles, and moving the arms.  Now, I do not see possible successes that other doctors have done with fat grafting.  However, I have seen patients who other doctors have presented at meetings with supposedly good results (on still photos). Those who have been unhappy enough to come to see me, look horrible.

When the crater deformity involves the skin stuck down to the chest, fixing the problem by removing the crater walls and fixing those sections also to the chest wall is not a good option.  Check out that link to the example above on extensive liposuction deformity.  However taking out even more surrounding fat, the defect can look better at rest or in a still photo.  When the crater is only a relative deformity with no adherence and some fat under the nipple.  Crater wall liposuction is certainly an option.

The best way to deal with this problem is prevention.  Picking the right doctor for the surgery is very important.  I just saw a presentation at a meeting where the doctor proudly showed how "good" his gynecomastia surgery was and the after surgery pictures were craters at rest!!!

Hope this helps,

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

Thats right. My right breast is normal. But my left one is sunken, but not only the areola, the whole breast is sunken.
But still i can feel some gland there.
Here are some pics

http://www.bilder-speicher.de/09011915364937.gratis-foto-hosting-page.html
http://img8.imageshack.us/my.php?image=p1802092006mg3.jpg

http://img26.imageshack.us/my.php?image=p180209200601yj3.jpg

http://img16.imageshack.us/my.php?image=p1802092007jy3.jpg

What do you say?
I think the surgeon did an agressive liposuction. There is not the same amount of fat like on the other side.
So, what i can da about this?

Best regards.

[DrBermant]

Dr. Bermant, the person shown on your www site - http://www.plasticsurgery4u.com/revision_gynecomastia/gynecomastia_bad_scar.html  Were you able to do revision on him?  If so, do you have any after pictures of that revision?

That patient had a deformity that I call "sucked dry."  The skin was stuck against the muscle with no fat over a wide extended area.  There were no local resources for reconstruction.  I have corrected many crater deformities, but I need some resources to work with for reasonable success.  When I can find the time, it seems I need to expand my revision gynecomastia section to show some examples. 

Hope this helps,

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

[DrBermant]

Is it pissible to fill the crater with muscle?

A Crater Deformity Complication after gynecomastia surgery is a term I coined years ago to describe the terrible results I have seen from other doctors misadventures when the skin is adherent to the underlying muscle / areola.  The extend of the defect can vary from a subtle depression to no fat left at all.  It can vary in extent from just a surgically caused inverted nipple to involving the entire chest as shown in this example of bad scarring after over aggressive liposuction of the male chest.

The deformity is one of missing fat.  Replacing the missing tissue with muscle is not a good option.  It may look good on a still photograph, but in motion, it does not.  Take a look at the various movies I have posted on the craters.  To fix this deformity, the missing fat is best replaced with fat.  My fat flap contouring brings fat with a blood supply from adjacent regions to fill the defect.  Bringing a blood supply has a much better chance of keeping the fat cells alive. 

Fat transferred by grafting frequently dies, shrinks, or firms up.  I have seen so many complications from other doctors' fat grafting where the transferred fat was just as firm or firmer than typical gynecomastia gland.  Filling the defect with firm fat or scar tissue does not look good on animation, flexing the muscles, and moving the arms.  Now, I do not see possible successes that other doctors have done with fat grafting.  However, I have seen patients who other doctors have presented at meetings with supposedly good results (on still photos). Those who have been unhappy enough to come to see me, look horrible.

When the crater deformity involves the skin stuck down to the chest, fixing the problem by removing the crater walls and fixing those sections also to the chest wall is not a good option.  Check out that link to the example above on extensive liposuction deformity.  However taking out even more surrounding fat, the defect can look better at rest or in a still photo.  When the crater is only a relative deformity with no adherence and some fat under the nipple.  Crater wall liposuction is certainly an option.

The best way to deal with this problem is prevention.  Picking the right doctor for the surgery is very important.  I just saw a presentation at a meeting where the doctor proudly showed how "good" his gynecomastia surgery was and the after surgery pictures were craters at rest!!!

Hope this helps,

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

Thats right. My right breast is normal. But my left one is sunken, but not only the areola, the whole breast is sunken.
But still i can feel some gland there.
Here are some pics

http://www.bilder-speicher.de/09011915364937.gratis-foto-hosting-page.html
http://img8.imageshack.us/my.php?image=p1802092006mg3.jpg

http://img26.imageshack.us/my.php?image=p180209200601yj3.jpg

http://img16.imageshack.us/my.php?image=p1802092007jy3.jpg

What do you say?
I think the surgeon did an agressive liposuction. There is not the same amount of fat like on the other side.
So, what i can da about this?

Best regards.

Standard Pictures for Revision Gynecomastia can better demonstrate the nature of the problem.

We are happy to help patients explore their concerns and options during a consultation or a Preliminary Remote Discussion for those wanting to minimize travel to Virginia.

If interested, Jane is my office manager.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.

Hope this helps,

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