Is there help for me??

[deuce00slt]

My first surgery for gynecomastia was 8 years ago.  I trusted my doctor and the direction I had to go in order for the insurance to pay for my treatment and surgery.  I went through a vascular surgeon who made sure I actually had the disease.  I did, and the surgery left me butchered.  I went to a plastic surgeon a year later to help improve how bad I looked, but 7 years later I still feel too embarrassed about what is under my shirt.  My quality of life still sucks, I think about who notices my chest every day.  I look in the mirror, feel my chest, and just think of how disgusting I look all the time.  

So I've decided to have a third surgery.  I went back to my plastic surgeon from 7 years ago and he remembered me.  He referred me to someone who was very nice and a great guy.  However, after reading posts here and some of the supporting doctor's website I"m wondering if I'm on the right path?  I've read posts from members with recessed nipples and the replies from the doctors and I'm just cautious that I'm not doing the right thing here.  Based on the photos I'm attaching can anyone let me know if I can be fixed?  Are my expectations too high for looking 'right' again??  I don't want to have to go through several more surgeries to fix this!

Thanks
Bob

[deuce00slt]

Does anyone have any comments?  Anyone left in a similar situation/result?  IF so, what did you do about it?  

Any advice would be appreciated!

Thanks
Bob

[Dr. Elliot Jacobs]

You are overweight, have lax skin, residual fat and caved-in (crater deformity) nipples.  Too much tissue was removed at one time.

Yes, improvement (not perfection) can probably be achieved with additional surgery.  But remember, you have scar tissue from two prior operations, which makes any new surgery more difficult and less predictable.

However, I do believe improvement can be had with additional lipo, skin tightening (which would result in scars -- but would be a decent trade-off for a trim chest) and some type of surgery to improve the nipples -- either flaps or skin grafts.

Dr Jacobs

PS  would be pleased to provide a free email evaluation -- just send me your real email address in a PM and I will provide some information to you.  EWJ.

[DrBermant]

My first surgery for gynecomastia was 8 years ago.  I trusted my doctor and the direction I had to go in order for the insurance to pay for my treatment and surgery.  I went through a vascular surgeon who made sure I actually had the disease.  I did, and the surgery left me butchered.  I went to a plastic surgeon a year later to help improve how bad I looked, but 7 years later I still feel too embarrassed about what is under my shirt.  My quality of life still sucks, I think about who notices my chest every day.  I look in the mirror, feel my chest, and just think of how disgusting I look all the time. 

So I've decided to have a third surgery.  I went back to my plastic surgeon from 7 years ago and he remembered me.  He referred me to someone with less experience than him who was very nice and a great guy.  However, I'm not sure he can make me look normal again and give me a chest that will fit my body and just look like a chest.  I've read posts from members with recessed nipples and the replies from the doctors and I'm just cautious that I'm not doin the right thing here.  Based on the photos I'm attaching can anyone let me know if I can be fixed?  Are my expectations too high for looking 'right' again??

Thanks
Bob

Yes, some Crater Deformities from Bad Gynecomastia Surgery have revision possibilities. Options depend on the original problem, what was done, the nature of local tissues remaining behind, and other factors best explored during an evaluation.

While typically weight loss before surgery is better than weight loss after, this is one exception. The local fat can sometimes be a resource for rebuilding the defects.  Taking the edges of the craters down with further liposuction looks terrible.  Before you agree to that option, try to see before and after surgery pictures of that choice. The results I have seen from other doctors' attempts at that option have been worse that the original problem.  This is especially true of how the tissues move on animation. Sometimes the option involves skin reduction which has the compromise of the scars.

To minimize travel patients use our Preliminary Remote Discussion. 

Standard After Gynecomastia Surgery Pictures can shed much more detail on the nature of the problem.

Jane is my office manager and can explain the process.  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

[deuce00slt]

Thank you for your replies!  Is a silicon implant an option that I should explore?  Would it be wiser to do a fat flap versus grafting?  Will grafts last?  Will they feel and move like normal fat there?  Is it all really up to the doctor as to what he thinks is possible? 

THanks!
Bob

[dyngano]

Bob,

It's hard to tell from your photos, but it looks like the crater appearance is at the very least exacerbated, or maybe entirely created by the excess fat you have surrounding the nipple and over the rest of your chest. I recommend that you send your pictures to Dr. Karidis in the UK, and in fact to every one of the top surgeons discussed on this board. If they say they can help, they can.

If it means that much to you, you shouldn't only approach those surgeons within a convenient travelling distance, but get the opinion of the top 5 or 6 surgeons wherever i the world they may be based.

[Dr. Elliot Jacobs]

I would avoid a silicon implant at all costs -- it simply would not be natural for you.

Best to consult an experienced gyne surgeon who can evaluate what you have and can make recommendations for surgery.

Dr Jacobs

[DrBermant]

Thank you for your replies!  Is a silicon implant an option that I should explore?  Would it be wiser to do a fat flap versus grafting?  Will grafts last?  Will they feel and move like normal fat there?  Is it all really up to the doctor as to what he thinks is possible? 

THanks!
Bob

Silicone implants are designed to imitate breast tissue. Breast tissue on a male chest = gynecomastia. That would not be a good choice, especially on animation.  I have used many fat flaps to fill such defects. Tissue that brings its own blood supply is superior to a graft that depends on the getting new blood supply to survive.  Partially surviving fat grafts tend to be firm, also like gland.  For a fat graft to look like, feel like, and move like fat, it has to have a very high survival rate. That is why some that teach this technique for use in lips put the fat in vascular muscle. Putting fat in the chest muscle will look really bizarre on animation!

Before someone performs a silicone implant for this defect (or for that matter any option), look for before and after pictures that such a technique works.

Hope this helps,

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