Bursa Crater Deformity - looking for UK fat FLAP surgeons?

[DannyH]

Hi there,

I had gynaecomastia surgery 15 years ago, where both puffy glands were removed. Oddly, all was fine for c. 3 years until (due to bodybuilding / natural degradation?) grooves appeared under both nipples. More than just looks, it's the conflicting sensations when upper torso moves: all movement seems to converge on the areolae and thus l get conflicting sensations where the circle of fat around the nipples moves along the surface plane, but the sensation ends abruptly where the fat ends, and then also there's the feeling of the nipple surface moving against the scar tissue in the central circlular pit ("divot") directly under each nipple, and also perhaps the feeling of the nipples pressing down or being pushed up - all in tandem with the other aforementioned animation sensations. I don't know if l'm explaining it well but it's a pretty confusing set of conflicting sensations, there's no coherent smoothness to it, and l've borne it out for many years and it never gets better.

I have no current photos but it's much like the example posted by the late Dr. Bermant here: http://www.plasticsurgery4u.com/revision_gynecomastia/revise_crater_complication_canada.htm

In fact that is how l discovered the proper name for my exact condition. It's more than just a crater deformity, there's little / no tethering of the areolar skin to muscle. There appears to be scar tissue formed under each nipple. Thus, the effect shows most on animation.

Of course there are also visible grooves. I'll try to post some photos if anybody specifically asks.

What l've tried:

Three different lipotransfer operations with two independent surgeons 6 years apart.

First op (Surgeon #1 - BAAPS registered l think?): Felt beautiful, no more conflicting sensations, chest looked smooth. Then literally from Day 3, the fat began solidifying, and by Day 5 deep grooves had reappared and by Day 7, all the fat was gone.
Second op (Surgeon #2 - BAPRAS registered): Approx. 50ml each nipple. Felt beautiful, no more conflicting sensations. Fat did NOT solidify. However, it was all gone by Day 14. At least l got a few more days of feeling normal!
Third op (Surgeon #2 - BAPRAS registered): Approx. 100ml right nipple, 60ml left nipple. Surgeon complained that he couldn't put more than 60ml in because there was scar tissue in the way under left nipple, but didn't seem to want to remove that scar tissue? Felt great on the right side, felt not so great on the left side, because the transfered fat was in patches. Once again, fat did not solidify. However, it was all gone by Day 20. At least l got a few days of feeling normal! And yes, 100ml was probably too much anyhow (maybe 60ml too), but l had never intended for 100ml to actually survive. In fact l had asked for 150ml both sides.

As you might guess, l have hardly any money left. Very upset about my entire life etc. BUT on the flipside, l don't believe the universe is real anyway hehe (l won't bore you ... this is just my coping mechanism sometimes). Still though, for myself, my areolae, and for future generations, l feel it's important to have one last crack at this problem!


I'm considering:

- Semi-permanent fillers - what are your thoughts? I'm thinking of fillers that last 2 years + . I'm told this is a bad idea because of the scar tissue under each nipple.

- Areolar flap suturing - l'm told this would leave a prominent scars, and just create new grooves? At this point, l wouldn't mind scarring as long as these awful conflicting nerve sensations can be brought to an end (caused by my breasts being reduced to a circle of fat around each nipple, but directly under each nipple the fat is absent, it's just a pit of scar tissue).

I'd especially welcome feedback from UK surgeons, but l'm aware there are some North American experts here, and l would be extremely grateful for their feedback too. For practical purposes though, l would really need a local surgeon.

My makeshift sig:

# Please nobody mention fat transfer! For me at least, it doesn't work.

# Mothers: don't let your male kids be fat at puberty, it can cause male breast growth! (And don't do drugs during pregnancy, for same reason.)

# If you are considering gynaecomastia surgery - lose weight first, and try just liposuction first, without gland removal, or at least: find a decent surgeon who KNOWS how to avoid crater scars

# Crater scars are WORSE than having male breasts as far as l'm concerned!

^^^ these are just my opinions, feel free to redact them, moderators!

[Dr. Elliot Jacobs]

It seems as if you have been around the block a few times.  
It would be most helpful if you could post some photos of yourself in different poses.
Your experience mirrors my feelings about treatment of craters with fat grafting -- it just doesn't seem to work.  For years, I have used fat flaps to deal with crater deformities -- but one needs sufficient adjacent fat around the crater in order to create a flap.  And treatment is also limited if the crater is too wide.

Anxious to see some pictures.

Dr Jacobs

[Calabria]

Hi Danny.
I need a revision like yours. reading your post i got a bit sad cause here in Brazil all surgeons indicates the fat graft solution.

Like u said, i've thinking on others things to fill it up rather than fat.. what are u thinking on?

Hi there,

I had gynaecomastia surgery 15 years ago, where both puffy glands were removed. Oddly, all was fine for c. 3 years until (due to bodybuilding / natural degradation?) grooves appeared under both nipples. More than just looks, it's the conflicting sensations when upper torso moves: all movement seems to converge on the areolae and thus l get conflicting sensations where the circle of fat around the nipples moves along the surface plane, but the sensation ends abruptly where the fat ends, and then also there's the feeling of the nipple surface moving against the scar tissue in the central circlular pit ("divot") directly under each nipple, and also perhaps the feeling of the nipples pressing down or being pushed up - all in tandem with the other aforementioned animation sensations. I don't know if l'm explaining it well but it's a pretty confusing set of conflicting sensations, there's no coherent smoothness to it, and l've borne it out for many years and it never gets better.

I have no current photos but it's much like the example posted by the late Dr. Bermant here: http://www.plasticsurgery4u.com/revision_gynecomastia/revise_crater_complication_canada.htm

In fact that is how l discovered the proper name for my exact condition. It's more than just a crater deformity, there's little / no tethering of the areolar skin to muscle. There appears to be scar tissue formed under each nipple. Thus, the effect shows most on animation.

Of course there are also visible grooves. I'll try to post some photos if anybody specifically asks.

What l've tried:

Three different lipotransfer operations with two independent surgeons 6 years apart.

First op (Surgeon #1 - BAAPS registered l think?): Felt beautiful, no more conflicting sensations, chest looked smooth. Then literally from Day 3, the fat began solidifying, and by Day 5 deep grooves had reappared and by Day 7, all the fat was gone.
Second op (Surgeon #2 - BAPRAS registered): Approx. 50ml each nipple. Felt beautiful, no more conflicting sensations. Fat did NOT solidify. However, it was all gone by Day 14. At least l got a few more days of feeling normal!
Third op (Surgeon #2 - BAPRAS registered): Approx. 100ml right nipple, 60ml left nipple. Surgeon complained that he couldn't put more than 60ml in because there was scar tissue in the way under left nipple, but didn't seem to want to remove that scar tissue? Felt great on the right side, felt not so great on the left side, because the transfered fat was in patches. Once again, fat did not solidify. However, it was all gone by Day 20. At least l got a few days of feeling normal! And yes, 100ml was probably too much anyhow (maybe 60ml too), but l had never intended for 100ml to actually survive. In fact l had asked for 150ml both sides.

As you might guess, l have hardly any money left. Very upset about my entire life etc. BUT on the flipside, l don't believe the universe is real anyway hehe (l won't bore you ... this is just my coping mechanism sometimes). Still though, for myself, my areolae, and for future generations, l feel it's important to have one last crack at this problem!


I'm considering:

- Semi-permanent fillers - what are your thoughts? I'm thinking of fillers that last 2 years + . I'm told this is a bad idea because of the scar tissue under each nipple.

- Areolar flap suturing - l'm told this would leave a prominent scars, and just create new grooves? At this point, l wouldn't mind scarring as long as these awful conflicting nerve sensations can be brought to an end (caused by my breasts being reduced to a circle of fat around each nipple, but directly under each nipple the fat is absent, it's just a pit of scar tissue).

I'd especially welcome feedback from UK surgeons, but l'm aware there are some North American experts here, and l would be extremely grateful for their feedback too. For practical purposes though, l would really need a local surgeon.

My makeshift sig:

# Please nobody mention fat transfer! For me at least, it doesn't work.

# Mothers: don't let your male kids be fat at puberty, it can cause male breast growth! (And don't do drugs during pregnancy, for same reason.)

# If you are considering gynaecomastia surgery - lose weight first, and try just liposuction first, without gland removal, or at least: find a decent surgeon who KNOWS how to avoid crater scars

# Crater scars are WORSE than having male breasts as far as l'm concerned!

^^^ these are just my opinions, feel free to redact them, moderators!

[Helpme55]

Hi, I just felt I should come on this forum and make a few posts to let people know that the fat flaps can work for corrective surgery.  I just had it done with Dr. Elliot Jacobs in NYC, and while I am still healing it is amazing how much he was able to fix the crater issue I suffered from for years. HE FIXED THE CRATER!!  I would not go the route of fat transfer and only work with a doctor who really understands the fat flap technique. Good luck.

[DannyH]

Hi Danny.
I need a revision like yours. reading your post i got a bit sad cause here in Brazil all surgeons indicates the fat graft solution.

Like u said, i've thinking on others things to fill it up rather than fat.. what are u thinking on?

Hi my friend, l'm considering fat flap surgery. It will cost between £10k-£20k here in the UK. That's if it is even possible, sometimes it's not possible.