Can a Crater Deformity Be Fixed After Gynecomastia by Going to Gym?

Your incisions will go through a maturation #process after gynecomastia surgery. For the first few months they will be red and possibly raised and/or firm. As the scar matures, after 6-12 months, it becomes soft, pale, flat, and much less noticeable. You may experience numbness, tingling, burning, “crawling”, or other peculiar sensations around the surgical area. This is a result of the #healing of tiny fibers which are trapped in the incision site. These symptoms will disappear. Some people are prone to keloids, which is an abnormal scar that becomes prominent. If you or a blood relative has a tendency to keloid formation, please inform the doctor. Also, as you heal, the area may feel “lumpy” and irregular. This, too, decreases with time, and massaging these areas will help soften the scar tissue. The #compression garment helps reduce the swelling, and the longer it is worn, the more quickly you will #heal. It can also assist in the retraction of the skin. If you have any concerns about #healing, its best to ask questions of your surgeon or their nursing staff. It's possible the indentations can be addressed with cosmetic filler(s) if eligible.

The short answer is no.  Contour deformity may likely require revision liposuction or fat grafting.  Good luck
and be safe.John T.
Nguyen, MD, FACS, FICSDouble Board
Certified Plastic Surgeon

                  Contour
irregularities are not uncommon following surgical excision of glandular
gynecomastia. In most cases these deformities are relatively minor and don’t
require treatment. They usually respond to massage and compression in the
immediate post-operative period.

                  In
some cases these deformities may be severe and require secondary surgical
intervention. The majority of these cases require fat grafting and liposuction
of the surrounding areas to improve contour.

                  It’s
impossible to know what will be required to correct your particular deformity
without a physical examination. It does seem that minimal subcutaneous fat is
present and the under surface of the areola is attached to the pectoralis
muscles causing obvious distortion with movement. It appears that the magnitude
of your tissue deformity is severe with resultant crater formation.

                  Based
on these findings it’s unlikely that this deformity can be corrected without
fat grafting. It’s appropriate to wait at least six to twelve months following
surgery to allow resolution of swelling before proceeding. Consultation with
your surgeon regarding treatment options for this problem is appropriate at
this time. 

A true crater or dish deformity is a problem.  It can not be correct without some type of revision surgery.  Sometimes it requires fat transfer, liposuction of the surrounding area for blending, excision of more glandular tissue or a combination.  The gym will not help.

Probably not. It might ba able to be improved upon with further fine liposuction towards the "edges" in order to improve the contour. If the nipples are "stuck" down to the muscle that would be a harder fix.

I am sorry that you have had this experience with gynecomastia reduction surgery. Surgical reduction of gynecomastia seems as though it would be relatively simple and straightforward – just ‘remove the lump’ and the chest will look normal. But it is actually a deceptively challenging procedure that requires detailed preoperative evaluation and planning, surgical expertise, and careful attention to detail in the operating room with assessment of chest contour several times over the course of the surgery with the patient in upright sitting position.
In my practice we see a fairly significant number of patients who have had gynecomastia surgery elsewhere and who find themselves with post-surgical chest contour problems. During preoperative assessment of these patients, it is important to determine how each of the following anatomic concerns contributes to the visible contour deformity:
Condition of the overlying skin, with particular attention to whether or not skin laxity and/or skin tethering is part of the problem
Degree to which breast tissue has been over-resected, and whether or not there are adjacent areas where breast tissue has been under-resected
Volume of fatty tissue excess (or areas of fatty tissue under-removal) peripheral to the area where breast tissue has been removed
Extent of post-surgical scarring which can tether skin and subcutaneous tissues, altering chest area appearance in neutral position and/or with arms raised
The good news is that the vast majority of these post-surgical contour problems can be corrected, and many of them can be corrected completely so that patients have a normal post-correction chest contour, with surgical scars that are inconspicuous or even completely invisible to the casual observer.
Areas of persistent soft tissue depression can be restored by means of structural fat grafting, where fat is harvested by hand from areas of fat excess using small syringes (most commonly the flanks in gynecomastia patients) then processed and reinjected using small blunt cannulas. Areas with major soft tissue deficits / depressions may require solid fat and/or dermal-fat grafts in order to achieve complete contour correction.
The last issue that is assessed and treated is laxity in the overlying chest skin, which can permit some soft tissue contour problems to persist, at least to some degree, if it is not addressed. The dermis of areolar skin is much thinner than the dermis of the surrounding chest skin, which means that it has an inherently lesser ability to contract and smooth out following the correction of problems involving the underlying fat, breast tissue and scar tissue.
Secondary gynecomastia surgery patients frequently require excision of lax and redundant areolar skin. Alternately, removal of a crescent of the surrounding, non-areolar chest skin may achieve a normalization of the vertical areolar diameter, which tends to collapse and shorten in some patients following removal of subareolar breast tissue. As with primary gynecomastia surgery patients, every effort is made to limit the amount of skin excision that is performed, as surgical scars become ever more obvious as the amount of skin excision increases.
Your best bet for correction of a post-gynecomastia surgery contour abnormality is treatment in a practice that is experienced with this complex problem. Make sure your gynecomastia contour correction surgeon is a board-certified plastic surgeon, ideally an ASAPS member. Members of the American Society of Aesthetic Plastic Surgeons are board-certified, residency-trained plastic surgeons who have significant experience in cosmetic plastic surgery.
Also, make sure your board-certified surgeon can clearly explain to you their stepwise plan for chest area contour correction, ideally while drawing on your chest with dry erase markers to outline each step of the plan, and that they can show you side-by-side ‘before and after’ photographs of gynecomastia post-surgical contour correction cases that show clear improvements in chest contour with scars that are faint or invisible. 

Hi milad,Thanks for the post. A crater deformity is caused by either over-resection of tissue or scar tethering, or both.  Going to the gym to build the pectorals muscle will not correct a crater deformity caused by over-resection.  This is because the pectoralis muscle will increase in size evenly, meaning that it will not be bigger in the area where the tissue was resected, which is what would be needed to fill the defect.  Fat flaps or fat grafting will be required. Sincerely,Dr. Dadvand

Unfortunately, I do not think that going to the gym is going to help. It would behoove you to be examined in person by a well-trained/experience board-certified plastic surgeon for good advice.  Best wishes.

Whenever it is possible local Adipose (fatty tissue) flap should be done.This method of treatment has the best chance to succeed.Lipo suction of the surrounding tissue and fat transfer are less predictable.
 

Hello and thank you for the question.

This is a common sequelae, especially in men who have large gynecomastia masses requiring resection.  Your options are to perform lipoplasty in the surrounding area to blend in the deformity, to perform a fat transfer into the deformed area, or a combination of both. This correct treatment or combination will depend on the severity of your deformity.  Consult with Board Certified Plastic Surgeon for an evaluation and to discuss your options. 

Kindest Regards,

Glenn Vallecillos, M.D., F.A.C.S.