Crater deformity 4 months post op, is this fixable?

[Albattal]

Before I explain I would just like to say I have asked my surgeon all these questions multiple times over my surgery recovery and he has both disregarded and worked around my questions to avoid addressing them. So I have kind of been forced to ask other surgeons.

I am 4 months post op. My surgeon did excision of gland, removed some of the gland, but not all, and performed liposuction as well. There are 2 issues:

1.) There is wrinkling and folding of the skin and the nipple-areolar complex. My surgeon had only addressed this issue, stating that continuing massaging and waiting for the skin to tighten will fix this problem from the period of 6 months to a year. (I have been massaging for a few months daily consistently, and I am continuing).

2.) This is my primary concern and my surgeon has failed to address it. As you can see the general shape of the chest itself - rather than the nipple-areolar complex - looks concave and sunken in. This can be seen in all of the side-view pictures.

My questions are: 

What do you believe are the cause of these problems? Over resection? Too much liposuction? Uneven liposuction?

Do you foresee these 2 separate issues realistically have a chance of fixing with time? If so, what type of procedure would it be? If not, do you foresee revision surgery to be possible and could it achieve satisfactory results, or did the surgeon do too bad of a job to where it can’t be fixed well.

Also, if a revision is done with fat flap/fat transfer, are those results permanent? Permanent as such the fat placed in those areas fills in the crater and acts as normal fat would in those areas, by gaining and losing fat there when the rest of your body does? I would hate to do a fat transfer only for it to eventually disappear and need to constantly add fat to those areas to keep it from being depressed/concave.

Thank you for your time.

[Miguel Delgado MD]

Albattal
Your situation is due to over resection of tissue with liposuction and possible gland excision.  It is difficult to say without the pre-op photos.  At this point you have skin excess and over resection of tissue. This is difficult to repair.  You will most likely require fat grafting because you do not have enough fat for fat flap rotation and possible peri-areolar skin tightening. You need to be evaluated by a gynecomastia expert for a plan. Yes, your situation can greatly be improved. Good luck.

[Dr. Elliot Jacobs]

Sorry to hear about your results.  Unfortunately, no amount of additional massage or prayer is going to change the results that you see now.

It appears that too much tissue was removed under the areolas, which has resulted in a concave appearance as well as crater deformities.  There may also be irregular residual areas of excess tissues, which could be suctioned so as to minimize the appearance of the concave areas.

The skin crevices, etc are due to the fact that the skin tried to tighten as much as it could, but without support from underlying tissues (which were removed), the skin had no where to go but to infold upon itself.  Missing, of course, are photos of you prior to surgery as well as a history of your weight gains and losses, etc, which could contribute to laxity of the skin.

You really need to be evaluated by a gyne specialist in person in order to get a realistic idea of how much improvement, if any, could be achieved.  Many of the docs on this site have such expertise -- it would be worthwhile to consider traveling in order to get that expertise.

Good luck!

Dr Jacobs