My pre and 6 mo. post-op gyno pictures + video. Deformity and lumps

[outofshape]

I underwent gyno surgery on September 29th 2011 by a well-known surgeon in Thailand where i live.
He's well known for facelifts, is US board certified (Had a practise in california for 20 years) and does a lot of breast reductions in women. Gyno surgery is done 10 times / year on average. Because he does a lot of breast reductions in women i thought gyno surgery would be an easy task for him.
Also because the price was almost as high as surgery in the US i expected good quality.

I'm now 6 months post-op + 2 kenalog syringes/shots 4 weeks after and am very disappointed in the result so far.

I went back to the surgeon 4 weeks ago for a check-up and i received a treatment two full syringes kenalog injected under and around my areaola's.

The 2 full syringes of kenalog didn't melt down all scar tissue (if it's scar tissue) so there are still a lot of lumps to be felt and seen. If that isn't bad enough the kenalog shots have created craters in my chest (which seem to get bigger!). I suspect the kenalog chest in my right areola has damaged my pectoralis muscle. It's like there's a hole in my right pec and it looks really bad.
I wasn't informed about possible creaters/deformity until after the shots. I did some reading about kenalog shots prior to the treatment but didn't come across information about this sideffect.

The surgeon probably also removed too much tissue from around my right pec. A hollowness can clearly been seen and felt. I suspect i'll need revision surgery to fix that but i will wait 4 more months to see if the craters and hollowness will fill up and if the scar tissue will melt down a bit more.

I'm glad the gyno is almost gone but the hollowness and deformity is something i really want to have fixed if it doesn't get better in the next 4 months. I was promised a flat chest with minimal scarring and this is clearly not it.

The surgeon always does revision surgery after approx. 1 year if the final result is not pleasing but i don't know if i want him to do my revision surgery. If a surgeon doesn't deliver good quality the first time then i don't think it's wise to go with him for a second OP. Although i think he's a good surgeon (based on reviews from others) and the hospital is superb I wish i had gone with one of the more popular gyno-specialised doctors in the US but i was too lazy to travel there and wanted to have the operation done as soon as possible. In the end i probably still have to travel to the US...

Feedback from surgeons on this board will be much appreciated.

EDIT: DON'T KNOW what happened but the pics didn't resize properly. Please right click > view/see picture on the picture you wish to see.

6 months post-op + 2 kenalog shots:


Shot at 2012-04-20


Shot at 2012-04-20


Shot at 2012-04-20


Shot at 2012-04-20


Shot at 2012-04-20


Shot at 2012-04-20


Shot at 2012-04-20


Shot at 2012-04-20


Shot at 2012-04-20


Shot at 2012-04-20

PRE-OP:


Shot at 2012-04-20


Shot at 2012-04-20


Shot at 2012-04-20

[outofshape]

No comments yet... it must look really bad. I've always had a bit of a non-symmetrical chest but now the contour is really messed up. This is probably not good promotion for gyno surgery.

Can anyone tell me if the craters caused by the kenalog shots can be fixed if they don't fill up in the next couple of months?
I'm wondering why i've gotten such deep craters, has the kenalog been injected into my muscle?

[puffynipsman]

Have you considered posting this in the Ask a Doctor section? You'll likely get a quick and helpful response over there.

[Dr. Elliot Jacobs]

I agree with your concern about the contour irregularities.  It is difficult to ascertain, however, how much is due to possible over-resection of tissue and how much is due to the kenalog injections.  If kenalog is not administered properly, it can result in fat atrophy, which basically can mimic a crater deformity from over resection of tissue.

In any event, there appears to be a deficiency of tissues causing contour irregularities.  Revision surgery can usually be contemplated at 6 months after surgery and two months after the last kenalog injection.  Revision surgery should try to restore contours utilizing either fat flaps or fat grafts (the latter may have to be repeated in order to get the best result). 

Best to take your time and do your research to find the best surgeon possible.  Good luck!

Dr Jacobs

[outofshape]

I agree with your concern about the contour irregularities.  It is difficult to ascertain, however, how much is due to possible over-resection of tissue and how much is due to the kenalog injections.  If kenalog is not administered properly, it can result in fat atrophy, which basically can mimic a crater deformity from over resection of tissue.

Thank you for your reply dr. Jacobs.

Can fat atrophy reverse itself, or are the fat cells destroyed by the kenalog shot?
In my case the surgeon removed too much glandular tissue next to areola on the right pec. The wrongly administered kenalog shot that followed caused fat atrophy so the over-resection of glandular tissue gets visible, resulting in a crater deformity. Is that about right?

So to conclude the plastic surgeon did two things wrong; over-resection of glandular tissue and administration of the kenalog shot in the wrong way.
Over-resection is most visible on the right pec above the areola when standing in a relaxed pose.

In any event, there appears to be a deficiency of tissues causing contour irregularities.  Revision surgery can usually be contemplated at 6 months after surgery and two months after the last kenalog injection.  Revision surgery should try to restore contours utilizing either fat flaps or fat grafts (the latter may have to be repeated in order to get the best result). 
Best to take your time and do your research to find the best surgeon possible.  Good luck!

I will certainly go for revision surgery if it doesn't improve by a lot within the next 3 months.
I've visited your website and am impressed by the amount of before and after pictures featured.

Do fat flaps or fat grafts create a natural effect when flexing the muscles? When i hear fat flap i think of a strip of fat folded and then stitched on top of the depresion/creater. I would really appreciate it if you can explain a little bit in detail how that works and what should be expected.









Dr Jacobs
[/quote]

[Dr. Elliot Jacobs]

Can fat atrophy reverse itself, or are the fat cells destroyed by the kenalog shot?

Sometimes the fat atrophy produced by kenalog does reverse itself spontaneously (ie the fat cells are not destroyed) -- but it may take a year or more for spontaneous improvement.

Do fat flaps or fat grafts create a natural effect when flexing the muscles?

Both techniques may produce a natural effect -- but not always.  Remember, we are playing "catch-up" when doing revision surgery -- and there is a fair amount of scar tissue present as well.  One can never predict or guarantee how a revision operation will turn out -- the goal is improvement, not perfection.

I would really appreciate it if you can explain a little bit in detail how that works and what should be expected.

A fat flap can only be done if there is sufficient residual fat tissue surrounding the crater deformity.  In such a circumstance, surgery is performed to separate the surrounding skin from the surrounding underlying fat.  Then further dissection is performed at the level of the muscle (with the fat layer above it) so that only a layer of fat has been freed up.  Then the fat is gently advanced into the crater and either sutured to other fat flaps coming from the other direction.  Sometimes, if there is sufficient tissue, the fat flaps can be overlapped on top of each other to provide more bulk.  The major limiting factor is the extent of the scar tissue, the extent of the crater deformity, and of course the fat flaps are limited by the blood vessels that are attached to them which provide blood to the flaps.  If you pull the flaps too hard in trying to advance them, the nourishing blood vessels are stretched and narrowed and will diminish the flow of blood.  This could spell doom for the fat flap.

Dr Jacobs