Can anyone answer these questions?
-What exactly is residual tissue?
When I talk about residual tissue, I refer to tissue left that continues to deform the chest. This deforming tissue can be remaining gland, scar tissue, scarred firm fat, firm fillers or anything else that leaves the chest not looking good on animation or at rest.
Can anyone answer these questions?
-How much could fat grafts/fat flaps/treating scar tissue improve the appearance of my left areola?
I had already answered the question in a generic fashion in this prior post:
Options for revision of Crater Deformity Scars after Gynecomastia Surgery depend on the original problem, what was done, what resources are left, after care, scar care, how the patient healed, and many other factors best explored during an evaluation. I prefer to leave a natural layer of fat between the skin and the muscle that preserves natural motion of tissues. When the layers scar together and there are adequate resources to revise the scars, then revision surgery may be an option. I have revised many such deformities from other doctor's operations. Unfortunately I also have seen so many other patients where there is just nothing left to rebuild with. A Fat Flap Gynecomastia Sculpture takes nearby fat, trying to maintain its blood supply, and filling the defect with living fat. Fat taken from other parts of the body without a blood supply are grafts. A good deal of such transferred fat dies and usually becomes firm. This firm tissue can be just as firm as other scars or gland and does not look good especially on animation, flexing, and lifting arms. The fat flap moves like normal fat.
Firm fat, dermal fillers, and molded implants all can have values for scars, but just do not look good on tissues that are supposed to move.
Evaluating photographs on success of fat grafts, flaps or other techniques can depend on lighting, different cameras used, angles, and other factors. One critical one is seeing the before and after comparison from multiple angles. All can be used to hide effects of craters. That is why I evolved my Standard Pictures to Evaluate Gynecomastia Revision Surgery. Even more critical, but harder to make are my Standard Video / Movies to Evaluate the Male Chest. Watching tissues move, as in a volleyball player's exposed chest, is proof of the effectiveness of a technique.
Making something look good for a still picture can be a partial achievement. It reminds me of the story of the fantastic prosthetic ear for the patient missing an ear. It looks great until it falls off during a dinner party into a soup bowl! Each option has its limitations. I have never seen fat grafts used with any technique that look adequate on animation, that includes work from those teaching such techniques at meetings. Watching fat grafted results move in person or movies tells the story to me. The results of even the field's experts are just not something I like and so do not offer. Our field of plastic surgery keeps on moving forward with evolution in techniques. I am looking forward to the day that such techniques really offer a satisfactory solution.
Hope this helps,
Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery
I just saw 2 more patients after crater deformities from other doctors' misadventures who were unhappy with fat grafting and or dermal fillers. It amazes me that they told me that their doctors could not show them successful before and after pictures for fat grafts or fillers. I have yet to see effective results, especially with moving tissues. This includes patients from other doctors seen in my office, meetings, the literature, or the web. Dermal fillers replace firm dermis which has the consistency of gland and nothing like fat. Dermal fillers tend to melt away over time. Fat grafts tend to die off even in well vascularized tissue. Put them in scar, and more dies off to leave a firm deformity. Put them in muscle under the scar and that structure looks bizarre on animation. This firm fat also comes closer to the consistency of gland. That is why I consider such options as a failure in planning and design and prefer my
Fat Flaps where the tissue still is attached to its blood supply increasing the chance for the fat to remain soft, feel like fat, and move like fat. Look at some of the glands removed on my
Gland Gallery Photos, especially the male mastopexy patients which tend to have the biggest defects. Now imagine the craters that would have been created without the fat flap reconstruction done of those patients. You can then see before and after pictures / movies by clicking on the links for those glands and see the results of motion.
-Are the chances good that these methods would help me?
We are glad to help you learn specifics, but you will need to have a consultation or a
Preliminary Remote Discussion. That is where I can examine the problem, evaluate what was done, learn about medical history and other factors that enter in such a recommendation. Any doctor offering specific recommendations without that detail is potentially entering into a doctor patient relationship that they may be responsible for such advice which is based on insufficient information.
Hope this helps,
Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery
Topic: Before & After Pics, 4 years later - 18 years old - Crater Deformities? (Read 18618 times)
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