How to prevent the crater effect if surgeon removes gland last?

[Steve Dell]

I understand Dr. Bermant will remove the gland first than smooth out the area of fat to avoid the crater deformation. Sometimes he will also put fat flaps over the area to support the nipple area when the arms ar raised.

My question is how to the rest of the surgeons who don't remove the gland first prevent this type of thing from happening?

Basically will it require at last some extra liposuction after the gland is removed to smooth out this possible crater effect? My understanding is that the gland removal creates a hole in the fat and the extra liposuction will remove the fat(  basically leveling out that hole that creates the crater effect) ?

Please let me know how a surgeon can prevent a crater effect when the gland is removed ?

Thanks

[jakeyboy08]

This is a question you may want to ask the other surgeon's who you are thinking of getting surgery with.

You got it in one the surgeon level's out the chest and removes excess fat which was around the Gland.

Jake

[DrBermant]

I understand Dr. Bermant will remove the gland first than smooth out the area of fat to avoid the crater deformation. Sometimes he will also put fat flaps over the area to support the nipple area when the arms ar raised.

My question is how to the rest of the surgeons who don't remove the gland first prevent this type of thing from happening?

Basically will it require at last some extra liposuction after the gland is removed to smooth out this possible crater effect? My understanding is that the gland removal creates a hole in the fat and the extra liposuction will remove the fat(  basically leveling out that hole that creates the crater effect) ?

Please let me know how a surgeon can prevent a crater effect when the gland is removed ?

Thanks

My Dynamic Technique is outlined in great detail on my site and extends way beyond what you describe targeting gland first so that you do not end up with problems like the Puffy Nipple Complication after gynecomastia surgery. When there is enough fat overall, then my Fat Flaps are not needed. When the gland is a major component, then the Fat Flaps become a powerful step to target gland first.

Now some doctors will claim they do not need to target gland first or that their method gets rid of the gland. However, there never seem to be more than one or two pictures to evaluate before / after surgery as proof of the method. It certainly is one explanation for the many patients I have seen from around the world who come to me complaining of contour deformity after surgery done elsewhere. No the gland is not cancer, but it certainly does not compress like fat does. That is why when flexing muscles or lifting arms up overhead can be revealing to just how good a result is after surgery or the degree of the problem before.

To really evaluate if a method works, you need to see how the contour looks from many different directions. Look for at least my Standard Pictures for Gynecomastia Surgery. There should be at least Frontal, Frontal with arms up overhead, Frontal arms on hips muscles relaxed and then flexed. Left and right oblique images, Left and Right Side images, puffy nipples are even more critically evaluated with reverse oblique pictures.

To really evaluate after revision surgery these flexed views are more critical such as flexing and relaxed oblique and side pictures.

Movies are even more critical of contour issues. One unhappy patient just thanked me for putting his story up demonstrating how bad his results looked like after revision surgery done elsewhere. His craters were fixed by removing just about all of the fat along his chest. Something that looked OK from the still picture view point. But when looking at himself in the mirror each morning the patient was embarrassed about himself in how his chest looked as he moved it. The videos are quite a story watching. The patient had come to me to learn what I had to offer, but there was nothing left to use. The crater defect was too large. Instead I worked hard to help him through a difficult emotional healing even though I did not create the defect. Here is a recent response:

This is amazing. Thank you for doing this. I feel like i finally get to tell my story.

The bottom line is not how the doctor gets there, it is how the results look in real life, not just one or two views showing how "great" a method is for contouring. The result should look good playing sports, swimming, and enjoying life with shirt off and not being embarrassed about the body.

Look for that documentation and proof before picking your surgeon. That is one of the best methods of preventing a crater defect, seeing what that doctor's methods really look like beyond the one or two still pictures.

To show to a degree what I am referring to here are 2 pictures from that example I was talking about:

Extended Crater Defect Relaxed

Extended Crater Defect Flexed

Unfortunately these are only still pictures. The videos are much better demonstrating how still pictures alone do not tell the entire story.

Hope this helps,

Michael Bermant, M.D.

[Dr. Elliot Jacobs]

There are many surgical techniques to treat gynecomastia -- not just one doctor's technique.  Each surgeon develops his own method which works well in his own hands.

For me, I can never be sure how much breast tissue is present.  One can be fooled by "how hard the tissue feels."  There are times I approach an operation fully ready to excise a lot of breast tissue.  And then I find that after liposuction thru a nick in the skin on the side of the chest, that I have been able to remove everything without even having to make a peri-areolar incision.  The results are smooth, flat and contoured -- and indeed the chest looks normal in all positions and during movement as well.  This happens about 40% of the time.  That means I have saved the patient a peri-areolar scar (as good as it may heal) 40% of the time!!

For the other 60% of patients, the liposuction has removed at least some of the peripheral edges of the gland, which makes it smaller and isolated to the area just under the nipple. It has also contoured the remainder of the chest, including removing some fat from the lateral chest (which is very common in men).   It is then that I do make a peri-areolar incision and very precisely remove the excess gland so that the contours are smooth and flat and contoured.  At times I do leave a bit of gland directly under the skin of the areola so as to support it and prevent cratering.  This re-capitulates the normal condition of the male chest.  Bear in mind, ALL men have breast tissue directly under the areola -- even those with absolutely normal chests. And believe it or not, guys with normal appearing chests and who have breast tissue under their areolas have smooth contours which move well with motion -- they don't require fat under their areolas in order for their chest to move normally.

Once in a while, I do use fat flaps to reinforce the projection of the areola.  There is ALWAYS some fat left intact from my liposuction surrounding the nipple so that this can be done.  These fat flaps have been used by all plastic surgeons for decades!

Bottom line, again, is that there is more than one technique that can secure a fine result for a patient.  But choose your surgeon carefully and make sure he is sufficiently experienced in gyne surgery.

Dr Jacobs

[bharat]

There are many surgical techniques to treat gynecomastia -- not just one doctor's technique.  Each surgeon develops his own method which works well in his own hands.

For me, I can never be sure how much breast tissue is present.  One can be fooled by "how hard the tissue feels."  There are times I approach an operation fully ready to excise a lot of breast tissue.  And then I find that after liposuction thru a nick in the skin on the side of the chest, that I have been able to remove everything without even having to make a peri-areolar incision.  The results are smooth, flat and contoured -- and indeed the chest looks normal in all positions and during movement as well.  This happens about 40% of the time.  That means I have saved the patient a peri-areolar scar (as good as it may heal) 40% of the time!!

For the other 60% of patients, the liposuction has removed at least some of the peripheral edges of the gland, which makes it smaller and isolated to the area just under the nipple. It has also contoured the remainder of the chest, including removing some fat from the lateral chest (which is very common in men).   It is then that I do make a peri-areolar incision and very precisely remove the excess gland so that the contours are smooth and flat and contoured.  At times I do leave a bit of gland directly under the skin of the areola so as to support it and prevent cratering.  This re-capitulates the normal condition of the male chest.  Bear in mind, ALL men have breast tissue directly under the areola -- even those with absolutely normal chests. And believe it or not, guys with normal appearing chests and who have breast tissue under their areolas have smooth contours which move well with motion -- they don't require fat under their areolas in order for their chest to move normally.

Once in a while, I do use fat flaps to reinforce the projection of the areola.  There is ALWAYS some fat left intact from my liposuction surrounding the nipple so that this can be done.  These fat flaps have been used by all plastic surgeons for decades!

Bottom line, again, is that there is more than one technique that can secure a fine result for a patient.  But choose your surgeon carefully and make sure he is sufficiently experienced in gyne surgery.

Dr Jacobs

Hello Dr Jacobs,

Request you to please share your thoughts on the below thread.
www.gynecomastia.org/smf/38/which-grade-do-i-fall-under/