Any guys here who did fat grafting/transfer to the chest?

[Dr. Elliot Jacobs]

You may not have heard, but fat grafting to the female breast (for both cosmetic and reconstructive purposes) is the latest rage in plastic surgery.  Literally hundreds of cc's of fat are carefully injected with very precise instruments into very specific locations.  We are witnessing a revolution in how to enlarge female breasts -- and hopefully in the future we may able to limit the use of actual breast implants and instead provide a naturally enlarged female breast with fat (which is what most female breasts are made of).  These operations are also a double win for the female patient because lots of liposuction is required in order to harvest the fat for eventual placement in the breast.  Thus we can reduce the abdomen, thighs, etc at the same time as the breast is enlarged.

Obviously technique is very important -- and the precise details of various techniques are still being worked out.  But fat injections have been done for decades.  There is no reason why fat injections cannot be done for revision purposes after gyne surgery.

Also, fat itself has huge numbers of stem cells by itself.  There are techniques to concentrate the stem cells, but these require discarding a fair amount of the harvested fat.  These techniques are best used for only small areas requiring fat injection.

In revision gyne surgery, fat flaps are quite useful -- I do use them when appropriate.  But fat grafting offers additional avenues for treatment.

Dr Jacobs

[DrBermant]

I think Bermant's fat flap technique sounds pretty good.

But, for anyone with less resources (like me possibly), I might look into Stem Cell Fat Transfers.  I'd like to know more about whether this would be ideal for a male revision surgery.  It is said that new blood vessels form using this procedure, and that a vast majority (80-90%) of the fat survives.

The only remaining concern is whether some of the fat calclifies afterward, which would look bad on animation.

It seems promising anyway.

Yes, my fat flaps have worked and I have demonstrated their effectiveness in this particular deformity with before and after surgery pictures and video on how they move.

Have you checked out the piece about stem cells being used in unethical fashion by 60 minutes? Search google for: 21st Century Snake Oil "60 Minutes" Cameras Expose Medical Con Men Who Prey on Dying Victims. That piece was for bizarre use of stem cells. Stem cells are in their early stages of what they may offer. To date I have yet to see one successful use of fat grafts or stem cells to fix a crater defect that looks good on animation or even more stringently feels like fat not firm tissue like residual gland. I have had several patients come to me after attempts elsewhere that they did not like. So, do your checking and investigation carefully before considering an option.

Fat graft use in women is a totally different matter for breast enlargement. Like a breast implant you are trying to duplicate the firm nature of a female breast. Fat grafting that ends up firm is fine for that female breast. For a male with gynecomastia, trading a defect for something that feels like breast tissue (not fat), moves like breast tissue, and bounces like breast tissue is not a good goal unless the patient is trading for a compromise contour that has limitations. Leaving a gynecomastia surgery deformity patient with a breast like mass (read gynecomastia recurrence by surgical method), is truly a limited achievement.

The premise of my above posts in this thread still stands. If a doctor has a working method that functions for male chest deformity disasters from bad surgery, then they should be able to demonstrate such success with more than just one or two still photographs or words alone. Again, the results should reduce the stress of having that deformity such that the individual feel whole again to play sports and live life with their shirt off as a choice. Transparency about the limitations of a technique, how many operations it took to get there, are also important factors to consider especially if there are compromises to be made.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737