Revision with Dr Bermant (pictures included)

[scope]

Let me first give some history about my case. I've had gynecomastia since I was 14 years old but I did not care for them until I started college. I really wanted to get rid of them fast so by second year I can have the freedom to do many things. I had surgery when I was 19 years old and everything went fine--or so I thought. I don't want to go into much detail, but the doctor left me with a crater deformity and a visible scar, and my nipples looked flat and deformed in the heat. Although I could wear a shirt easier now, I was very depressed that I couldn't take it off or wear anything tight. This, in additional to a lot of other problems I've had caused me a lot of stress during my college years. Years passed by and I miraculously was able to make money, do my research and have surgery with Dr Bermant.

If you visit Dr Bermant's website (www.plasticsurgery4u.com) it's incredible. I haven't seen such a detailed website with such detailed information. I don't think there's any other site on the web discussing about gynecomastia as much as his site. There are many doctors who can perform gynecomastia surgery, only a few who can fix deformities from previous surgeons, and only one that is able to back it up with pictorial evidence and knowledge. Best of all, he was only a short flight away across the border.

At first I opted for the remote package, but I realized that pictures cannot show my deformity well. I decided to come and he did a thorough exam, realizing that pictures would not show my problem and was glad that I came in. He explained that nothing can be perfect and there are risks. There was a surgery date available this week as someone did cancel, and I was fortunate to have it since I am not a drug user nor have anything that would cause problems in the surgery room.

Surgery went well and I did not need painkillers similarly to before. The crater deformity has been fixed. He was also able to replace the visible scar but it's hard to see with all the steri strips covering it. Currently I am crossing my fingers that the scars will heal and don't want to jynx anything and react much, but so far I am pleased.

Pre-op pictures (The pictures don't show the crater effect as much as animation):



Surgery pictures:



Post-op 10 days:



I'd also like to say that the office manager, Jane, is the nicest and friendliest person I've ever talked and if there was someone escorting you into heaven, it would be her. If you have any questions, feel free to ask me here or PM me. I'm currently trying to make sure that people don't end up in a situation similar to mine. Thanks again to Dr Bermant.

[clevelandguy1980]

Your pictures appear that you didnt have a bad crater effect before surgery while 'relaxed." Did your nipples "crease" in when you flexed. I know what you mean by animation as mine stick to the chest wall when I lift my arms or strech out. But you can really see them when I flex.

[clevelandguy1980]

I also noticed more gland removed? Wow didnt look like you had anymore in there, but hey it looks great.

[scope]

I also noticed more gland removed? Wow didnt look like you had anymore in there, but hey it looks great.

Thanks. The problems, such as nipple creasing and crater effects are seen significantly above room temperature or while lying down. Again it's very hard to show but I assure you it was awful and is now fixed .

[leaf]

How much did your revision cost in US dollars?

[clevelandguy1980]

I also noticed more gland removed? Wow didnt look like you had anymore in there, but hey it looks great.

Thanks. The problems, such as nipple creasing and crater effects are seen significantly above room temperature or while lying down. Again it's very hard to show but I assure you it was awful and is now fixed .

Sounds like your case is like mine, chest looks great when cold, but when the temperature rises there is a visible crease, and when u flex a hole. Glad to hear he was able to correct it. I know it sucks to pay twice, when it should have been right the first time. What gets me even more mad is that I looked at a bunch of before and after photos he had and they all looked great. I even told him I was concerned about a "crater" effect, and he assured me that he does so many not to worry. Once the surgery was done I was left with craters and he blamed it on my skin not tightening enough. The Dr. was board certified, and was not cheap. Now when it's all said and done I will have spent about 18,000 after my revison. Let us be a lesson to all, ask to see movies with people flexing or go somewhere else. Pictures alone do not tell the whole story about a surgery experience. Let us be a lesson to all out there checking out surgery options. Ask your Dr. specifically the techniques he uses to prevent cratering, or you will be sorry like us and pay twice.

I will be going to see Dr. Bermant next month so I will also be posting my crater effect which is very pronounced when flexing, and even visible when relaxed. Before and after photos to follow.....and hopefully a happy me.

[scope]

How much did your revision cost in US dollars?

Just under five digits for me, but keep in mind that costs vary depending on what needs to be done.

[DrBermant]

I also noticed more gland removed? Wow didnt look like you had anymore in there, but hey it looks great.

Thanks. The problems, such as nipple creasing and crater effects are seen significantly above room temperature or while lying down. Again it's very hard to show but I assure you it was awful and is now fixed .

You are correct, it can be very difficult to show a Bursa Crater Deformity on still pictures alone. In person, the contour problem is obvious. The prior link shows how easy this defect is seen on examination. The series of still picture shows how there is a crater wall around a depression. The movie shows the problem even better. Nipple Areola skin floats in this variation of the Crater Complication Scar After Gynecomastia Surgery.  That is why lying down, and on motion, the defect reveals itself, while upright it is hidden. The stimulation of a cold room is enough to tense the areola muscle flattening the contour hiding the problem that reveals itself again in a warm room.

I have posted Revise Crater Complication documentation to more easily compare the before and after surgery pictures and movies of this unusual deformity.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

[Grandpa Bambu]

I also noticed more gland removed? Wow didnt look like you had anymore in there, but hey it looks great.

Sheesh.... yeah really.... where did all that come from? So let me get this straight... You had all that taken out, and had your PS 'fill-in' the not very evident 'craters'? However, your pre-op and post-op pics look almost identical?  

Hmmm.........


Well, as long as you are happy... that is what matters most... 


GB...

[clevelandguy1980]

I also noticed more gland removed? Wow didnt look like you had anymore in there, but hey it looks great.

Thanks. The problems, such as nipple creasing and crater effects are seen significantly above room temperature or while lying down. Again it's very hard to show but I assure you it was awful and is now fixed .

You are correct, it can be very difficult to show a Bursa Crater Deformity on still pictures alone. In person, the contour problem is obvious. The prior link shows how easy this defect is seen on examination. The series of still picture shows how there is a crater wall around a depression. The movie shows the problem even better. Nipple Areola skin floats in this variation of the Crater Complication Scar After Gynecomastia Surgery.  That is why lying down, and on motion, the defect reveals itself, while upright it is hidden. The stimulation of a cold room is enough to tense the areola muscle flattening the contour hiding the problem that reveals itself again in a warm room.

I have posted Revise Crater Complication documentation to more easily compare the before and after surgery pictures and movies of this unusual deformity.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

Wow thanks for posting that video it seems almost like my case when u can only notice it above room temperature, but if u feel it your finger can feel the void and i have an inverted nipple on one side. It feels like a ring of gland surrounding my nipple as it will move and it is very dense not like fat. It almost seems like when my PS did my procedure that he cut into the gland and removed what was underneath the nipple but left a ring of gland around it? Anyways I will be your next crater revision challenge next month with my surgery booked!

[Grandpa Bambu]

Surgery went well. The crater deformity has been fixed. He was also able to replace the visible scar but it's hard to see with all the steri strips covering it.

Well dude, it's been two weeks since you posted your pics... The steri-strips must have fallen off by now... Post a few pics of your results so far...

Thanks...  

GB...

[DrBermant]

Surgery went well. The crater deformity has been fixed. He was also able to replace the visible scar but it's hard to see with all the steri strips covering it.

Well dude, it's been two weeks since you posted your pics... The steri-strips must have fallen off by now... Post a few pics of your results so far...

Thanks...  

GB...

Actually I ask my patients to try to leave the steri-strips on longer. They provide reinforcement to a wound or in supporting the areola nipple complex early in healing and are like a belt and suspender approach. This can be inconvenient for showing others and just the pleasure of seeing the result. But it is like a Christmas package, waiting until the time is right is often better. Being patient and having the end plan of an optimal scar is more important.

You can see another example of my moving a scar originally placed by another surgeon to the edge of the areola in this Revision of Gynecomastia Surgery from New York. That case was different, too much had been left behind. The deformity looked worse as flexing muscles pushed the nipples out further. This bursa crater patient's problem was the lack of support of the nipple areola region making the problem look much worse on his back or when warm. In my opinion, results should optimally look good living life, not only in a standing up photograph.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

[Grandpa Bambu]

Surgery went well. The crater deformity has been fixed. He was also able to replace the visible scar but it's hard to see with all the steri strips covering it.

Well dude, it's been two weeks since you posted your pics... The steri-strips must have fallen off by now... Post a few pics of your results so far...

Thanks...  

GB...

Actually I ask my patients to try to leave the steri-strips on longer. They provide reinforcement to a wound or in supporting the areola nipple complex early in healing and are like a belt and suspender approach. This can be inconvenient for showing others and just the pleasure of seeing the result. But it is like a Christmas package, waiting until the time is right is often better. Being patient and having the end plan of an optimal scar is more important.

Doc B...

My steri-strips were falling off by the end of the second week... I ended up just pulling them off myself... I guess the hot water from my showers had a hand in the streri-strips falling off...

Do you not use any sutures to close up your peri-areola incisions?

Also... scope's chest pre/post-op looks almost identical... Where did you get all that adipose tissue from?

Anyways.... scope.... when you do remove the steri-strips, take some pics and post them if you will...  Thanks dude...  I'm very interested to see your results...  

GB...

[DrBermant]

Surgery went well. The crater deformity has been fixed. He was also able to replace the visible scar but it's hard to see with all the steri strips covering it.

Well dude, it's been two weeks since you posted your pics... The steri-strips must have fallen off by now... Post a few pics of your results so far...

Thanks...  

GB...

Actually I ask my patients to try to leave the steri-strips on longer. They provide reinforcement to a wound or in supporting the areola nipple complex early in healing and are like a belt and suspender approach. This can be inconvenient for showing others and just the pleasure of seeing the result. But it is like a Christmas package, waiting until the time is right is often better. Being patient and having the end plan of an optimal scar is more important.

Doc B...

My steri-strips were falling off by the end of the second week... I ended up just pulling them off myself... I guess the hot water from my showers had a hand in the streri-strips falling off...

Do you not use any sutures to close up your peri-areola incisions?

Also... scope's chest pre/post-op looks almost identical... Where did you get all that adipose tissue from?

Anyways.... scope.... when you do remove the steri-strips, take some pics and post them if you will...  Thanks dude...  I'm very interested to see your results...  

GB...

Identical except the crater defects are now gone and I preserved a natural contour of the remaining tissue! The scars inside the areola have also been moved to the edge.

I use anywhere from 2 to 4 different types of absorbable suture for this type of surgery in addition to the steri-strips. On some of the more extensive fascia sculpture cases I may also need some deeper permanent sutures for the long term support of the tissues. On some of the cases the suture selection actually can vary from one side to the other with the problems and sculpture needs being different.

You can actually see the edge of the crater defect fat that became my Fat Flap Sculpture used in this reconstruction. Go to the Bursa Crater Deformity Picture panel on this page: Bursa Crater Deformity. Go to the bottom most roll over picture and you can see a larger version of the actual crater fat wall I used during surgery to reconstruct the defect. The other roll over photos of that page were the best still images I could devise to demonstrate how bad the defect looked in person and on clinical exam. The next panel's video was the actual exam. 

I examine each gynecomastia patient lying down and standing up. Although I could see the major change in the deformity with position change, I could not figure a way to document that with pictures or movies. It is not just taking the pictures it is being able to reproduce the views before / after surgery.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

[Grandpa Bambu]

The scars inside the areola have also been moved to the edge.

How exactly do you 'move' a scar?

GB...