Why does surgery fail?

[Lardass1]

I know that this may seem to some a dumb question but why does surgery sometimes fail? I had surgery 6 months ago and it is now obvious that I will need revision on my left side as it looks not that much different to the way it was pre-op. Now, I understand that the surgeon removed both fat and tissue from the area so what exactly is growing back? I thought fat removed by lipo does not return and what about breat tissue if it is taken away too? I am resigned to having revision but I'm just curious that is it not obvious to a surgeon that he's leaving material behind that is likely to re-grow?

Answers please?

[slyblackdragon]

It is neccesary to leave some fat/gland behind for a natural contour of the chest. Correct and hormonal imbalance, don't use marjuana or steroids, don't drink in excess, etc and it shouldn't come back. And yes, fat can come back after being lipod out. Fat hyperplasia is the increase in number of fat cells.

[DrBermant]

I know that this may seem to some a dumb question but why does surgery sometimes fail? I had surgery 6 months ago and it is now obvious that I will need revision on my left side as it looks not that much different to the way it was pre-op. Now, I understand that the surgeon removed both fat and tissue from the area so what exactly is growing back? I thought fat removed by lipo does not return and what about breat tissue if it is taken away too? I am resigned to having revision but I'm just curious that is it not obvious to a surgeon that he's leaving material behind that is likely to re-grow?

Answers please?

There are several ways surgery can "fail."

Gland tends to be firm, fat soft.  Leaving too much gland behind is one common problem that can cause puffy nipples after gynecomastia surgery. 

That is why I prefer to target the gland first with my Dynamic Technique. This permits me to remove most of the gland and then sculpt the remaining tissue to minimize contour problems. 

Unfortunately any surgery technique, even radical breast mastectomy for male breast cancer can leave gland behind.  The problem is that there are fine fingers of gland that dissect between fingers of fat and can extend quite far into the chest.

You can see what I mean by fingers of gland here.

By concentrating on the gland first I am able to minimize the chance of breast regrowth.  It is very rare for my patients to have recurrence.  With my techniques and red flag before surgery evaluation system, I have only a few patients over the many years I have been doing surgery that I know have regrown.  However, gynecomastia surgery does not stop breast regrowth.  For patients having breast growth, I have advised for many years that they should get their problem under control before surgery.  Operating on someone who does not have a stable problem increases the chance of continued growth after surgery.  There are exceptions, such as young men with massive breasts that have not stopped growing.  That is why each case needs to be individually evaluated. 

Another series of problems include taking too much tissue, excessive injury of remaining tissue, or removing gland without contouring surrounding tissues which can all contribute to Crater deformities after Gynecomastia Surgery

Another issue is leaving loose excess hanging tissues of Male Chest Ptosis such as what you might see after major weight loss without adjusting them.  Areola ending up below the chest muscles just look strange as can loose wrinkled tissues that only shrink so much.  Male Mastopexy Chest Lift however, is a compromise between scars from skin reduction options and lifting / tightening tissues.

There are many other examples of issues that might lead to here that can be found on my website.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture