Revisions to FTM chest masculinization surgery. Can the concavity be fixed? Can my areolas/nipples be resized? (Photo)

I am truly sorry your chosen surgeon misrepresented her or himself as experienced in transgender mastectomies. Your anatomy obviously required skin-reducing mastectomies, nipple reduction, areola reduction, and reconstruction in a masculine fashion with nipple/areola complex (NAC) full-thickness skin grafts.You did NOT, as other respondents have stated, have "too much" tissue removed, nor should you have retained "a proper amount" of breast tissue. Your SHOULD have retained the proper thickness of subcutaneous fat above the actual breast glandular tissue--though this interface is not "sharply" defined, it IS visible with proper and careful dissection, and will leave the correct thickness of subQ fat whether the patient is thin or more full-figured. Removal of every cell of breast tissue by creating thin skin/fat flaps is how cancer mastectomies are performed, and what your chest looks like (even with "extra" skin "saved" for the plastic surgeon to perform breast reconstruction--as if we needed or wanted it; that wrinkled skin is the first thing we have to remove in performing cancer breast reconstruction). Also, the "normal" male chest does not have "a proper amount" of breast tissue--in fact, presence of breast tissue in a male is called gynecomastia ("female breast") and many men ask for its removal!A properly-performed top surgery for transmen who want as masculine a chest as possible involves removal of 99+% of breast tissue, reduction of excess skin (usually, but not always required if the amount of breast tissue is very small and the skin elastic), as well as reduction of the nipple, areola, and skin-grafting of the male-size NAC in the proper male position.Your surgeon performed subcutaneous mastectomies via crease incisions, did not properly reduce the nipples or areolas, and made an egregious misjudgement of the elasticity of your skin if s/he thought this would just "snap back" to something that even vaguely resembled a man's chest! This is NOT an operation that even a well-trained and ABPS-certified plastic surgeon can just "wing-it" and hope it is satisfactory. I'll bet this surgeon never agrees to do another, if s/he is properly fearful of a negligence or malpractice claim based on THIS outcome. "Trying and hoping" is not a good surgical plan. OK, I'll get off my soapbox. But this kind of result (and I'm far from perfect myself) really upsets me as it represents my profession. We should be better than to represent that we know something we so clearly do not, as in your result. Yours is not just a "bad outcome" that we all must occasionally live with.The good news is that this is totally (or nearly so) correctable by the proper surgery. Skin can be re-lifted and de-wrinkled as much as possible, the NACs reduced, and after removing the excess skin, grafted in a masculine position. Your results should be very close to what could have been achieved with a proper top surgery by someone truly experience in this specialized surgery, not just fully-trained (we receive little or no training in transgender surgery in virtually ALL plastic surgery training programs) and board-certified plastic surgeons. For some examples of my own top surgery patients (not just the best ones, but a true cross-section showing my own learning curve over the past two and a half decades of doing transgender surgery), click on the web reference link below.This CAN be corrected, and in most cases with nearly as good results as if you had had the proper operation instead of what you received. Best wishes! Dr. Tholen

The first surgery may have been performed by a board certified plastic surgeon, but they did not have the appropriate experience with transgender double incision mastectomy.  This can be revised.  The operation would have to be performed as it was intended.  I think you could have a good outcome.  You might have to travel to find a specialist in transgender surgery.

It is still early and the final result has not presented itself. You should wait at least 6-9 months to make a determination of how your chest looks. Then a revision can be performed if needed. Most likely a skin eduction and placing the lower incisions at an even level, removed excess skin, relocate the nipples and reduce their size. We do not see any pre operative photos so we cannot criticize your surgeon. These sometimes have to be stage procedures.

The treatment of FTM scars is different than normal scar revision and is a focus of our office. There are at least seven different priorities in FTM Top surgery revision, including:Reduction of High Tension Scar WideningRevision of Areolar scar width, size, position, and texture.Pigmentation correction for the scar and areola (especially if there is areolar/nipple hypo pigmentation)Textural improvement in scarsContour Correction of the scarContour Correction of the glandular part of the male breast pectorisPectoral footprint reestablishment (concavity or convexity)Hyperemia correction of the scarsOur office specializes in the management of Top Surgery corrections using a Hidef combination approach that minimizes scar visibility and maximizes the footprint of a male pec. This can be achieved with a combination of surgery, RF, laser therapy, intralesional injections, PRP, and scar modulation. Sometimes, liposuction or fat grafting is indicated. Best, Dr. KaramanoukianRealself Hall of Fame

It's usually suggested to wait 6 to 12 months depending on the reason for a #revision and it's still early in your healing. The ideal technique best for you is difficult to determine online by photos alone. There are several methods used which depend upon the patient’s breast or chest #size before surgery. Considerations include the #laxity of skin, the #size of the #areola, the amount of #fat and recent weight #gain or weight #loss. 
The most common procedures include the #periareola, #buttonhole, #double incision, and #anchor patterns. I often use #liposuction along with the double #incision for larger breasts, and, some variation for smaller breasts; depending upon the position of the areola. The female breast nipple and #areola are often centered on the breast. However, the nipple and areola are lower and closer to the outside edge of the #pectoralis muscle in the male patient. Shaping the side of the chest may also be required and can be performed with #suctioning; along with contouring of the muscle, as noted above, to provide the best definition for the chest. A board-certified plastic surgeon with specialization is such breast procedures will #confirm the technique best suited for your revision during an in-person evaluation. 

It's not unusual to require a revision to a top surgery.  This may take the form of removing excess residual skin, or fat grafting to fill out a concavity.  If in fact a revision is warranted it's usually best to wait until at least six months after the initial procedure to allow the healing process to stabilize and determine what irregularities will actually remain after the tissues have settled in.  In order to get a qualified, ethical, and expert opinion on your surgical options and expectations, schedule an in-person office consultation with a plastic surgeon certified by the American Board of Plastic Surgery.
Best of luck,Keith M. Blechman, MDNew York, NY

Hello, I can certainly understand your frustration with your result. Although I did not see your before pictures, I can only assume based on the  ideal "before and after" that you show, that your chest was similar to that before photo. If so, you very likely had the wrong procedure for your anatomy and this is why the result occurred. 
You certainly can have a revision to improve the appearance of your chest. However it is unlikely to ever look as good as it would have if it would have been done appropriately in the first place.  The concavity occurred because a flap of the appropriate thickness was not left behind. Only for this part, you may need fat grafting. This may or may not correct in one operation and you are likely to need additional  procedures.  A pectoral implant may be an option as well.  In either case,  I would only know by  examining you in person. 
You may also require resection of excess skin and possible free nipple grafts.  Again, I would need to see you in order to determine this. 
I know this sounds like a lot to deal with, but you need to know that the situation can be dramatically improved. 

I appreciate your question.It appears you had too much tissu removed.You would beenft from skin excision and fat graftingThe best way to assess and give true advice would be an in-person exam.Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.best of luck!Dr Schwartz

Thanks for the question.  Your result can certainly be improved with further skin reduction. You will likely benefit from fat grafting as well, as it looks like your subcutaneous fat has been over resected.  I recommend that you see someone who specializes in FTM transgender breast surgery.  Best of luck.

Your appearance can be markedly improved.  The scars and areolae can be moved and excess skin removed.  However, you need a very experienced surgeon in chest contouring surgery.