Before & After Pics, 4 years later - 18 years old - Crater Deformities?

[91deejay]

Hi guys.  I'm new here.  I'm so glad to have finally found a place where I can talk with people that have gone through and are currently going through the same thing I dealt/am dealing with.  Okay, so when I was 14, I had gynecomastia.  It was truly ruining my life, so I had surgery.  The results were good, but I wasn't quite satisfied.  My nipples didn't seem normal.  They were kinda folded.  And the left one was kinda inverted.  My doctor said it would work itself out if I kept massaging it.  He also advised me to lift weight.  In the post-op pictures below, my doctor had just manually stimulated my nipples, so they were hard.  

I did as I was told.  

Flash forward 4 years.  I'm 18 and am still not satisfied.  My chest just doesn't look good.  My nipples are still kinda folded, my left one in particular.  It is still (most of the time) inverted.  I've tried lifting weights, but I'm just not seeing any results; my chest is just flat as a board.  No muscle whatsoever.  

I'm thinking I have crater deformities.  

I'm not sure what to do.  Should I go back to my doctor?  I kinda feel like if he didn't do a completely great job the first time and has left me like this, how can I trust him to fix me this time?  Some of the options I've thought of are:
- Trying to develop pecs (Unsure if that would make it look better)
- Fat grafting? I saw on the internet that it could help crater deformities?

Any advice you guys can give me?  I'm open to anything.  I almost am as unhappy with my chest as when I had woman-sized boobs.  It's really eating away at me and hate having my shirt off around anyone.  This past summer, even my VERY closest friends made fun of how my nipples looked, laughing at how my left one was especially inverted.  That kinda hit hard.  

So please, profesionals and peers, help me out here.  I'd appreciate your advice so much!

-----------------------------------------
Before:
http://img191.imageshack.us/i/dscn4349.jpg/ - Front
http://img199.imageshack.us/i/dscn4351d.jpg/ - Side 1
http://img341.imageshack.us/i/dscn4350k.jpg/ - Side 2

-----------------------------------------
After (I'm thinking it was a couple weeks to a month after..it's been so long I'm not sure) (Also remember that my nipples are erect because the doc rubbed them out):
http://img63.imageshack.us/i/dscn7225m.jpg/ - Front
http://img8.imageshack.us/i/dscn7227e.jpg/ - Side 1
http://img707.imageshack.us/i/dscn7228s.jpg/ - Side 2

------------------------------------------
Present Day, Age 18:
http://img521.imageshack.us/i/postfront2.jpg/ - Front 1 (The inverted left nipple is very prominent)
http://img685.imageshack.us/i/postfront.jpg/ - Front 2
http://img706.imageshack.us/i/postfrontup.jpg/ - Front 3 (Arms Raised)
http://img251.imageshack.us/i/postside.jpg/ - Side 1
http://img534.imageshack.us/i/postside2.jpg/ - Side 1 (A little different angle)

[DrBermant]

Hi guys.  I'm new here.  I'm so glad to have finally found a place where I can talk with people that have gone through and are currently going through the same thing I dealt/am dealing with.  Okay, so when I was 14, I had gynecomastia.  It was truly ruining my life, so I had surgery.  The results were good, but I wasn't quite satisfied.  My nipples didn't seem normal.  They were kinda folded.  And the left one was kinda inverted.  My doctor said it would work itself out if I kept massaging it.  He also advised me to lift weight.  In the post-op pictures below, my doctor had just manually stimulated my nipples, so they were hard. 

I did as I was told. 

Flash forward 4 years.  I'm 18 and am still not satisfied.  My chest just doesn't look good.  My nipples are still kinda folded, my left one in particular.  It is still (most of the time) inverted.  I've tried lifting weights, but I'm just not seeing any results; my chest is just flat as a board.  No muscle whatsoever. 

I'm thinking I have crater deformities. 

I'm not sure what to do.  Should I go back to my doctor?  I kinda feel like if he didn't do a completely great job the first time and has left me like this, how can I trust him to fix me this time?  Some of the options I've thought of are:
- Trying to develop pecs (Unsure if that would make it look better)
- Fat grafting? I saw on the internet that it could help crater deformities?

Any advice you guys can give me?  I'm open to anything.  I almost am as unhappy with my chest as when I had woman-sized boobs.  It's really eating away at me and hate having my shirt off around anyone.  This past summer, even my VERY closest friends made fun of how my nipples looked, laughing at how my left one was especially inverted.  That kinda hit hard. 

So please, profesionals and peers, help me out here.  I'd appreciate your advice so much!

-----------------------------------------
Before:
http://img191.imageshack.us/i/dscn4349.jpg/ - Front
http://img199.imageshack.us/i/dscn4351d.jpg/ - Side 1
http://img341.imageshack.us/i/dscn4350k.jpg/ - Side 2

-----------------------------------------
After (I'm thinking it was a couple weeks to a month after..it's been so long I'm not sure) (Also remember that my nipples are erect because the doc rubbed them out):
http://img63.imageshack.us/i/dscn7225m.jpg/ - Front
http://img8.imageshack.us/i/dscn7227e.jpg/ - Side 1
http://img707.imageshack.us/i/dscn7228s.jpg/ - Side 2

------------------------------------------
Present Day, Age 18:
http://img521.imageshack.us/i/postfront2.jpg/ - Front 1 (The inverted left nipple is very prominent)
http://img685.imageshack.us/i/postfront.jpg/ - Front 2
http://img706.imageshack.us/i/postfrontup.jpg/ - Front 3 (Arms Raised)
http://img251.imageshack.us/i/postside.jpg/ - Side 1
http://img534.imageshack.us/i/postside2.jpg/ - Side 1 (A little different angle)

Revision Gynecomastia Surgery is an art form and skill. Look for actual before and after examples of that particular surgeon's skills and methods.  Choosing a gynecomastia surgeon is something I addressed in this post:

http://www.gynecomastia.org/smf/index.php?topic=16474.0

Options for revision of Crater Deformity Scars after Gynecomastia Surgery depend on the original problem, what was done, what resources are left, after care, scar care, how the patient healed, and many other factors best explored during an evaluation.  I prefer to leave a natural layer of fat between the skin and the muscle that preserves natural motion of tissues.  When the layers scar together and there are adequate resources to revise the scars, then revision surgery may be an option.  I have revised many such deformities from other doctor's operations. Unfortunately I also have seen so many other patients where there is just nothing left to rebuild with.  A Fat Flap Gynecomastia Sculpture takes nearby fat, trying to maintain its blood supply, and filling the defect with living fat.   Fat taken from other parts of the body without a blood supply are grafts.  A good deal of such transferred fat dies and usually becomes firm.  This firm tissue can be just as firm as other scars or gland and does not look good especially on animation, flexing, and lifting arms.  The fat flap moves like normal fat.

Firm fat, dermal fillers, and molded implants all can have values for scars, but just do not look good on tissues that are supposed to move.

Evaluating photographs on success of fat grafts, flaps or other techniques can depend on lighting, different cameras used, angles, and other factors. One critical one is seeing the before and after comparison from multiple angles. All can be used to hide effects of craters. That is why I evolved my Standard Pictures to Evaluate Gynecomastia Revision Surgery. Even more critical, but harder to make are my Standard Video / Movies to Evaluate the Male Chest. Watching tissues move, as in a volleyball player's exposed chest, is proof of the effectiveness of a technique. 

Making something look good for a still picture can be a partial achievement.  It reminds me of the story of the fantastic prosthetic ear for the patient missing an ear.  It looks great until it falls off during a dinner party into a soup bowl!  Each option has its limitations.  I have never seen fat grafts used with any technique that look adequate on animation, that includes work from those teaching such techniques at meetings.  Watching fat grafted results move in person or movies tells the story to me.  The results of even the field's experts are just not something I like and so do not offer.  Our field of plastic surgery keeps on moving forward with evolution in techniques.  I am looking forward to the day that such techniques really offer a satisfactory solution.

Hope this helps,

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

[91deejay]

Thank you Dr. Bermant for that useful information.  But now I'm looking for some personal opinions from everyone, telling me what they think; from my first pictures to what I look like now. 

[JJ37]

 hey 91deejay, I agree somehow with Dr.Bermant. It does not look that bad but there's room for some improvement. Since your chest is flat and ur young yu have great potenttial to put up some muscles, if you wish. Go for it... it will be worth a try. I saw Megan Fox's thumb nail and they are shorther than usual, looks odd...but who can't say the girl is gorgeous... hopefuly she doesn't care.  Youre a young handsome guy and can;t be left down by so little issue. Get it fixed if you wish, but don't make it let you down.  Enjoy your body !

[91deejay]

I understand what you mean.  It's just hard to enjoy your body when you think it should look a different way. 

So, anyone else think lifting some weights would do me some good?

[balalayka]

Actually deejay, in my opinion, lifting weights  will help you out a lot. When your muscles enlarge they will stretch the skin and push forward and hopefully straighten out things. Good luck.

[91deejay]

Any suggestion on certain types of exercises?  How long do you think it could take?

[JJ37]

you know it...but saying from someone else just confirms our beliefs... (that's why many people are in this forum, isn't it ?). I did some gym when I was 22-24y.o. I'd say you must start easy to avoid injuries and to verify your limits... high intensity, low reps puts volume, but remember the starter rules (at least that's what I learned from the experts at the gym 10 years ago..) high rep/low weight makes you get more muscle resistency. When you do pecs, let them recover for a week or as your gym expert recommends. Do not overtrain and add lean protein to your diet, if you don't care how you eat... better eat right ! If you do heavy weight, never forget the safety rules at the gym, otherwise you may stretch too much, get harmed and stop, which can frustrate and eliminate a lot of effort. This is chess. Can't beat the opponent too fast and needs to be smart. And, please, no drugs at all, cause THEY CAUSE REAL GYNO ! Moreover, results from steroids are ugly in my opinion... muscles may inflated, artifical, not strong. Sd why did I stop I just stopped because I got a grilfriend at the gym and she was so hot I convinced to let her leave the gym (she had just started, so she was gorgeous b4 any BB result). She left and I folowed her. Two years later, love finsihed, I got very busy and since then just got fatter Got worse after marriage but I plan to recover and reach 40y.o. better than when I was 30 !

Keep the good habits for life ! And enjoy it !

[JJ37]

by the way, my chest were some fatty at that time... and all my body was vey lean. Now got fixed ! I don't recall that P. (my ex-girlfriend) had ever felt she was with the wrong guy...nor did I with a girl I didn't deserve !

[91deejay]

Thank you for the advice.  But don't worry..I'd never do drugs. 

Anybody else have any opinions on my pictures and what I'm looking like now?

[91deejay]

Any other advice or opinions?  I'd greatly appreciate it!

[freefromG]

got some cratering my self (pics on a post of my somewhere - doesnt show it as well as in camera) I have to ask how long dd the area of cratering stay numb for...seems to get better slowly but at 5 mnths would have liked it to be well on its way.

[DrBermant]

got some cratering my self (pics on a post of my somewhere - doesnt show it as well as in camera) I have to ask how long dd the area of cratering stay numb for...seems to get better slowly but at 5 mnths would have liked it to be well on its way.

Numbness is the result of injury to the nerves. The greater the injury, the higher the risk that the lost sensation is permanent. What lost sensation persists by 2 years is probably permanent.

Hope this helps,

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

[Dr. Elliot Jacobs]

You have had a significant improvement over your pre-op condition.  However, no amount of exercise is going to improve your results.  I have no problem, though, with exercise and muscle development -- just don't plan on exercise alone to improve your condition -- you will be disappointed..

It appears that a slight bit of residual tissue exists on the right side and too much tissue was removed on the left side -- thereby allowing the nipple to cave in and crease.  Treatment (ie revision surgery) might consist of very careful removal of the excess tissue on the right and either fat grafts or fat flaps to fill in and re-elevate the left areola. There may also be some scar tissue tethering down your left nipple which would have to be treated as well.

First step should be to return to your original surgeon and discuss the problem with him.  If he doesn't feel comfortable or is unwilling to work on you, then you should search for a surgeon who is very experienced in gyne and gyne revision surgery.

Dr Jacobs

[91deejay]

got some cratering my self (pics on a post of my somewhere - doesnt show it as well as in camera) I have to ask how long dd the area of cratering stay numb for...seems to get better slowly but at 5 mnths would have liked it to be well on its way.

I stayed numb for quite a while.  Today, I think I have most of the sensation back, but I can tell I've lost some feeling in that area.  Not enough to complain about though.