Is this depression around the nipple permanent? Doctors please advise

[decimal]

Hi,

I had a liposuction and gland excision surgery done just 10 days ago.

While overall I m happy with the flatness of my chest compared to my before pics (http://www.gynecomastia.org/smf/index.php?topic=19388.0), I have become quite anxious regarding a depression of the skin next to my right nipple.

There is a crater-like formation close to towards the center of the chest, which gets deeper when I flex my chest muscles.
Can the doctors and senior members on this forum, please tell if this is normal during the beginning of the healing period, or is this a deformity tht I am stuck with for life  . I just want my chest to look flat nd natural whether relaxed or flexing 

The other nipple doesnt have this issue since the area right under and around the nipple is filled up with very hard scar tissue. Scar tissues are supposed to be bad, but I guess I am lucky how tht worked out in my case

[decimal]

Two more

[Dr. Elliot Jacobs]

I would certainly go back to your surgeon and discuss the situation.  More often than not, these things tend to iron out over time.  Sometimes there is more swelling on certain areas of the chest than others, which will create the false impression of a crater deformity.

No matter what, nothing can or should be done at this time -- you will have to be patient.  Usual healing time is 4-6 months.  If, at that time, there is a contour irregularity, a return to your surgeon to discuss the issue is suggested.  A surgeon has a number of options to help -- but that will have to wait. Oftentimes the issue resolves by itself -- making all your premature worrying for naught.

Dr Jacobs

[decimal]

Thank you for your reply Dr. Jacobs.

I asked my surgeon the same, and he said that I should just wait for the swelling to subside, and everything will be perfect.

Ironically, the fact that he is SO SURE that everything is fine is sort of unnerving for me.

Another reason, why I tend to take his advice with a pinch of salt is that, I got this surgery done in India while I am on vacation at home, and over here the when it comes to the objective of gynecomastia surgeries, flatness  of the chest is the main goal rather than aesthetics in all forms (tensed/relaxed); atleast, that is what I feel. As long as the chest is flat, nd has minimum scars, its considered a good surgery regardless of concavity or lack of a natural look. Once again, I could be wrong, but that is what my perception has been so far.

Not to sound too picky, but doc could you please comment if my nipples are too low compared to a typical male chest. Should I have discussed an internal breast lift as well with my surgeon? I was expecting him to bring it up/do it on his own, if he felt the need for it since the main objective of the surgery, from my side, was a good looking masculine chest.
I felt the above after looking up the following link which had a preop case quite similar to mine.
http://www.plasticsurgery4u.com/procedure_folder/male_breast/shortscar_male_mastopexy.html

[Dr. Elliot Jacobs]

There is a range of acceptability for nipple location on a male chest.  Men have different body types as well -- from the very muscular to the tall and stick thin.  Nipples also vary in location -- but they are all located just above the natural horizontal crease of the chest (actually, the bottom of the chest muscle).

I generally don't recommend moving nipples unless there is gross asymmetry or other problems.  Moving nipples usually involves additional external scarring -- which one wants to avoid during gyne surgery if at all possible.

Your nipples look fine -- don't worry about them.

Dr Jacobs

[DrBermant]

Hi,

I had a liposuction and gland excision surgery done just 10 days ago.

While overall I m happy with the flatness of my chest compared to my before pics (http://www.gynecomastia.org/smf/index.php?topic=19388.0), I have become quite anxious regarding a depression of the skin next to my right nipple.

There is a crater-like formation close to towards the center of the chest, which gets deeper when I flex my chest muscles.
Can the doctors and senior members on this forum, please tell if this is normal during the beginning of the healing period, or is this a deformity tht I am stuck with for life  . I just want my chest to look flat nd natural whether relaxed or flexing 

The other nipple doesnt have this issue since the area right under and around the nipple is filled up with very hard scar tissue. Scar tissues are supposed to be bad, but I guess I am lucky how tht worked out in my case

10 days is very early after surgery. As tissues equilibrate, Crater Deformities may get better, or even worse if they are masked by current swelling.  Craters can vary from something very subtle to gross deformities as shown on that page.

Most doctors do not use my Standard After Gynecomastia Surgery Pictures, especially the ones with arms raised up over the head and flexing muscles. These views really show fine details of the quality of the sculpture. Even subtle issues really show up in such animations images. Even more shows up with Standard After Gynecomastia Video / Movies. Such videos take a great deal of work to bring to the web. Results are really spectacular when, even early after surgery, such deformities, swelling, and bruising are missing.  Tissues do tend to evolve after surgery.  Evolution is usually better when starting out with a better non deforming contour.  Whether any one particular deformity evolves depends on the particular problem treated, what was done, the skill of the surgeon, and other factors. 

Another reason, why I tend to take his advice with a pinch of salt is that, I got this surgery done in India while I am on vacation at home, and over here the when it comes to the objective of gynecomastia surgeries, flatness  of the chest is the main goal rather than aesthetics in all forms (tensed/relaxed); atleast, that is what I feel. As long as the chest is flat, nd has minimum scars, its considered a good surgery regardless of concavity or lack of a natural look. Once again, I could be wrong, but that is what my perception has been so far.

Not to sound too picky, but doc could you please comment if my nipples are too low compared to a typical male chest. Should I have discussed an internal breast lift as well with my surgeon? I was expecting him to bring it up/do it on his own, if he felt the need for it since the main objective of the surgery, from my side, was a good looking masculine chest.
I felt the above after looking up the following link which had a preop case quite similar to mine.
http://www.plasticsurgery4u.com/procedure_folder/male_breast/shortscar_male_mastopexy.html

Low Nipples look weird on a male chest. The degree of ptosis or drooping can vary a great degree from patient to patient.

I designed my Short Scar Internal Lift for the marginal case when a low nipple can be restored to a more natural position with a surface scar often smaller than what most gynecomastia surgeons use for their normal cases. This internal lift incision is usually less than 3 cm (1.18 inch) in its stretch tumescent condition. (My normal gynecomastia incision is now often less than 1.6 cm (0.63 inch) when stretched with tumescence.)  Such issues are always best discussed before surgery. It is not good to assume such issues will be automatically be managed. That is why picking your surgeon is so critical. Unfortunately I have seen many patients who were unhappy with surgery first done in India.  I do not get the opportunity to see possible successes since they would have little reason to seek me out.

Hope this helps,

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

[decimal]

Thanks for your reply Dr. Bermant.

I am sort of worried now, but I guess I can do nothing more than keeping my fingers crossed and hope for the best.
I hope that I turn out to be one of the "possible successes" that you are referring to, with the exception that I will keep you posted of my positive experience .


Fingers crossedd!!

[decimal]

Just out of curiosity, what is the most common complaint/problem you get from surgeries in India?

Thanks

[DrBermant]

Just out of curiosity, what is the most common complaint/problem you get from surgeries in India?

Thanks

Major disfigurement such as a crater deformity is the most common mess I have seen from gynecomastia surgery done in India.  However, i have seen several less severe problems. 

Hope this helps,

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

[jigupse]

Just out of curiosity, what is the most common complaint/problem you get from surgeries in India?

Thanks

Dude, from the front view, your chest looks bloody fantastic..! It is as good as any of the 'most sucessfull surgery pics' posted on this forum. Yes from the side view you can see the depression, but I dont think its as severe as some of the cases that have been reported here in this website. From what I have read/heard, these tend to go away with time.

And yes, here in India most of the problems are resolved when you get a flat chest. Aesthetics would be good, but people with gyne here just want to have a normal flat chest so that they could feel confident about themselves. So that's why I presume even the docs just aim for flat...Anyways we have an anonymous group in Orkut with fair number of members, and most of the posts that we get point towards a satisfactory surgery. Only few members opt for revision  and the number of patients opting for 'foriegn' consultation is even less because of the cost which only a select few would be able to afford. The other factor in this part of the world is that working out in a gym is not as popular as, say countries in the west. And when people have surgery, they expect their chest to be like a Salman Khan (akin to Brad Pitt ), when actually they never work out, and thus will be disappointed with their surgery which apparently "went wrong"! So the perception that the Indian doctors are less skilled is..well just a perception and not reality.

Take care, and hope you heal well!

[decimal]

Thanks for your reply jigupse. I completely agree with your point, and in no way mean that Indian doctors are less skilled in any way. I firmly believe that the skill of a surgeon is geographically agnostic; you will find both good and bad ones anywhere in the world. But like I said earlier, the priorities are different over here.

I am a big afficionado of bodybuilding myself, and have been into it hardcore. After years of continuous hardwork, my body still couldnt get into the perfect shape because of this horrible gyne. I finally gave up in frustration, and my body gradually emaciated over a period of 5 years. The muscularity I have today is nothing in comparison to what I used to have. I had got my 4 pack , and I was on my way to the much longed for 6 pack abs  . However thats long back now. If only I knew back then that I have a medical problem which is very common and could be treated, I could not have been more happy....
Plus I have been in the US for the last 4 years, and seeing how much emphasis is placed on good physiques over there, especially in youngsters, I have begun to do the same myself. My point is that if I do resort to something as drastic as plastic surgery, I might as well get something close to perfection.

By now, you would wonder why I didnt get the surgery done in the US itself since I was there. The problem is that I am still a college student, and most of the funds that I get come from my parents. So I do need to be more financially prudent, bcoz ultimately its their hard-owned money and not mine, and whatever I do must be with their consensus and in their physical presence. I was shocked to see that my dad even agreed to a surgery even near home!! I had been brooding for months as to how to bring up the whole topic with my parents; I was expecting a long drawn out painful and frustrating period of never-ending discussions, fruitless attempts of persuasion, and condescending assurances that I am fine the way I am. After all, it IS PLASTIC surgery!!! I am sure you would be familiar with the stigma attached to cosmetic surgeries in India. Undergoing plastic surgery over here isnt something to be proud of or "manly". "You are perfect the way bhagwan/nature made you, dont tamper with it." Gawwd, I hate that bullshit! It is only recently that the public opinion towards corrective surgery is beginning to change. In the end, my only option was to quickly find the best surgeon near home in the shortest amount of time, before my parents started to have second thoughts about this; in fact my sister was already beginning to poison their minds about how I was being an immature narcissistic kid who had lost his mind, and needed to get his priorities straight and focus on his studies and getting a job rather than frivolous things as to how good his chest looked! It is incredible at times how unsupportive and insensitive people, who are the closest to you, can get! Anyways, that is besides the point.

Coming back to my results post op. Yes, I agree the pictures from the front dont look bad at all, however it looks much much worse in person. It is a rather conspicious dent from the center towards the nipple. The flow from the center of my chest to the nipple is not a smooth contour, but rather flat -- flat ---flat ---sudden bulge from my nipple pointing downwards---and then bulge---bulge--- bulge towards the side of my ribcage. It simply looks weird rite now as if I someone went in and scooped out all the tissue he could find at just one particular spot on my chest. I am just hoping that it evens out with time, and that its the scar tissue behind my nipple and towards the side which is creating this unevenness.

Have my fingers crossed!!

By the way, whats the link of the orkut group that you mentioned? Also, where are you from? Are you done with your surgery or still thinking about it?