3 years after surgery

[blocker]

Hello i had 3 years ago gyno surgery .. today i have big collapse when i up my hands in the air (look at photo 2) Im working almost everday on the gym but no results. What i have to do now ? Thanks for fast answer. (sorry for my English)

[Litlriki]

Sorry to hear about your problems after surgery.  From your photo, it appears that your surgeon did not do a good job of feathering the fat that surrounded the area where he excised your gynecomastia, and as a result, you have depressions under the nipple-areola region.  You might be able to make this less obvious by lowering your body fat through diet and exercise, which might thin the subcutaneous fat of your chest. Alternatively, and especially if your chest fat is resistant to weight loss, you might require a touch up procedure to suction the area to give it better contour, or possibly to do some fat injection if needed to fill in the defect a bit.  That would be better determined by a physical examination.  You should ask your surgeon about this, but he/she may not be skilled or experienced in treatment of gynecomastia, which is how you got the unsatisfying result demonstrated in the photo.

Good luck,

Rick Silverman

[Dr. Elliot Jacobs]

Your photos reveal a crater deformity, which is difficult to correct.

Sometimes it can be helped by performing additional lipo in the surrounding areas, thereby making the crater less noticeable.  Sometimes you need some fat grafting or fat flaps to fill in the craters.  And sometimes, unfortunately, nothing much can be done.

It would be best to consult with a PS in your area who has interest and considerable expertise in gyne surgery and gyne corrective surgery.

Dr Jacobs

[DrBermant]

Hello i had 3 years ago gyno surgery .. today i have big collapse when i up my hands in the air (look at photo 2) Im working almost everday on the gym but no results. What i have to do now ? Thanks for fast answer. (sorry for my English)

You have a variation of a Crater Deformity Complication After Gynecomastia Surgery. These defects come in different degrees. Lifting arms up over head and flexing muscles tend to reveal such contour issues, that is why I include them in my before and after pictures. A full Standard Photographs For Evaluating After Gynecomastia Surgery Problems, or even better Standard Video for Gynecomastia, will better demonstrate the extend of this deformity.

The thickness of the crater walls can reduce with weight loss. (They also can look worse with weight gain.) Making a crater wider with edge feathering liposuction, especially with the skin stuck down in the center, does not look good on animation. Fat grafts tend to become much firmer than normal fat, something like gland. Such firm fat does not look good on animation or when the thin muscle just under the areola relaxes. I have seen quite a few unhappy patients after attempts of these methods by other surgeons. So, before using a particular technique, look for before and after pictures that demonstrates how the result looks from multiple angles and how it moves.

I have used my Fat Flaps to bring the wall fat into the missing tissue defect with great success for many cases over the years. This form of reconstruction evolved from the large gland defects I was managing by targeting the gland first. Take a look at some of the sizes in this Gynecomastia Gland Gallery, especially the male mastopexy tissue removed. This slide show of tissue removed has links to the pages of what technique was used and the before and after pictures / movies of the results.

Hope this helps,

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

[Dr. Cruise]

You have two choices... one is to fill the defect, the other is to feather the tissue peripheral to the crater through liposuction.  Since you are already quite thin, I would recommend fat grafting to fill the defect. I perform a lot of fat grafting, but primarily on the face.  It is less predictable in the chest, due to the significant amount of motion of the pec muscles.  The procedure may be performed under local anesthesia, but would likely require 2 sessions to accomplish the desired result.  Quiet frankly, the revision may not  give you your desired results.  Unfortunately, revisionary gynecomastia is less predictable than primary gynecomastia.