Crater deformity after gynecomastia surgery: repair with fat graft or fat flap? (photo)

Fat grafting is probably the most reasonable treatment.Find a plastic surgeon with ELITE credentials who performs hundreds
of body contouring procedures and male breast reductions each year.
Then look at the plastic surgeon's website before and after photo
galleries to get a sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA

Sorry to hear you are having issues concerning your surgical results. The unfortunate crater deformity occurs after the removal of glandular tissue in the central area combined with inadequate contouring of the surrounding tissue. Your complaint of the crater being more prominent in certain arm positions is especially important as performing the operation with the arms in different positions may worsen a crater deformity when the patient moves his arms. The ability to contour the chest to create a smooth appearance is just as important as the adequate removal of the glandular tissue. Experienced plastic surgeons know that what is important isn't so much of how much tissue was removed, but rather, the tissue which is left behind which leads to a smooth, contoured chest. I usually correct a crater deformity thru fat grafting. With the improvement in fat grafting techniques and increased fat viability, structural fat grafting can be considered far and away the mainstay for correcting contour deformities after surgery. My advice is to seek out an experienced, board certified plastic surgeon who is affiliated with the American Society for Aesthetic Plastic Surgery (ASAPS).

Your #incisions will go through a maturation #process following #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.

Bruising and #swelling are normal and usually increase slightly after the removal of any tape or foam. The bruising will decrease over 3-4 weeks, but may last as long as 6 weeks. The majority of the swelling will be gone within the first 3-4 weeks. However, it may take 6-9 weeks to disappear completely. 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.

Hello Carl,I agree with your plastic surgeon that fat grafting in likely your best option for the contour irregularity seen in the photos you provided. Many times 2-3 fat grafting sessions are necessary to fully correct the defect.

Gynecomastia surgery can be very delicate and millimeters of fat differences in the subcutaneous space can cause this problem. Fat grafting is a reasonable option but may require more than one treatment.

Based on the pictures posted, there is a significant crater, probably from over-liposuction lateral to the nipple. Fat flap means moving some of the local fat over to the defect. That can be done provided you have enough fat to move without creating another crater. Fat graft involves liposuction of fat from other areas and preparing that fat then transferring that fat to the defect. To correct a liposuction problem may require multiple sessions to get the ideal results.Samir Shureih MD FACSsshureih@msn.com