Crater Deformity After Gynecomastia, Would a Revision Fix this? (photo)

I can't specifically say what can help, but the very least would be suctioning of the surrounding fat away from the areola.  If it's still depressed, a dermis fat graft could be placed beneath the areola to generate more caliber.

Hi Polkb10,Thanks for your question and photos. Some before pictures would definitely help in your assessment. DON;T lose hope. It is certainly fixable but you definitely need someone who does male breast revision surgery on a routine basis. It would be helpful to know what exactly was done before if only liposuction or direct excision.  A physical exam is needed to adequately address the area of concern and to visualize the skin elasticity or scar tissue that has formed since your surgery over 14 years ago.  I recommend expressing your concerns to your future plastic surgeon and seeking someone with lots of liposuction and fat grafting experience. It will require scar release and fat grafting without major surgical intervention. It could be done in 30-45 minutes in the office likely under local plus iv sedation. Good Luck.

 



All the best,



Carlos Mata MD, MBA, FACS



#moobs   #revisionsurgery     



Board Certified Plastic Surgeon

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. 

Your problem was most likely do to over resection of your breast tissue beneath your nipple. Revision gynecomastia surgery is often difficult and requires a well trained board certified plastic surgeon with experience in redo male breast surgery. An exam is critical to give you an opinion but most likely fat transfer is required. The below link will direct you on how to find the best plastic surgeon.

Judging from the photos, I suspect you would need revision surgery including scar release, revision liposuction of the chest, and possible fat grafting to the subareola region.  Consult with a board certified plastic surgeon in your area.  Good luck
and be safe.John T.
Nguyen, MD, FACS, FICSDouble Board
Certified Plastic Surgeon

This is a easy and straight forward problem to correct.  Your crater deformity is ideal for a fat flap to.to close the depression.  I have a video on some one exactly like you to give you an ideal of how good your result could be

First let me say that 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, 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 
There is always much more to consider than the overgrown breast tissue mass when treating primary (not previously operated) gynecomastia patients. One must pay close attention to the surrounding subcutaneous fat excess which is present in the majority of patients, as this must be treated – and treated in a manner that ‘feathers’ the breast tissue and fatty tissue removal peripherally so that there is no obvious demarcation between the area where tissue has been removed and the area where no tissue has been removed. Also, the chest skin must be carefully assessed in order to determine whether and to what degree it contributes to the preoperative appearance of breast tissue excess.
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.
I frequently will start a post-gynecomastia contour problem correction procedure with fat redistribution with no fat is being removed. During this phase of treatment we use flared cannulas which are highly effective in releasing subcutaneous scar tissue and redistributing / smoothing the subcutaneous fat layer. If there are any areas of fatty tissue excess following fat redistribution, these can be carefully reduced by low-volume liposuction using very small, non-flared liposuction cannulas.
Persistent, tethering bands of scar tissue can be corrected with scar ‘subcision’ using ‘V-dissector’ fat grafting cannulas. These cannulas have at their tips a V-shaped cutting surface that is highly effective at releasing scar bands that tether the skin and subcutaneous tissues and distort the surface anatomy of the chest skin.
As mentioned above, the patient is assessed in upright sitting position after completion of each step of the surgical procedure, as this is the only way to confirm the degree of improvement that has been achieved – and what additional correction is still required. The O.R. table flexes at the waist, allowing the back of the table to be elevated until it is almost perpendicular to the lower half of the table. In this manner a patient under deep IV sedation or general anesthesia can be examined in upright position, which of course is the meaningful position for chest aesthetics.
Areas of residual breast tissue excess are marked while the patient is in upright position. These areas can be reduced by two means: by use of an arthroscopy shaver introduced via a tiny incision in the underarm area, and/or by direct excision using small incisions along the border of the areolas. Breast tissue is extremely dense, similar to cartilage in consistency, and therefore only very minimal amounts of breast tissue can be removed by means of liposuction.
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 polkb10,Thanks for the post and photos.  You would befit from a revision where fat flaps could be mobilized and rotated into place underneath you areolae. This has the highest chance of success but is contingent on you having enough fatty tissue in your chest. Another option is to remove fat from another portion of your body and graft it under the cratered areas. Seek a plastic surgeon experienced in gynecomastia surgery and especially revision gynecomastia surgery.Sincerely,Dr. Dadvand

Thank you for the question and pictures.

Yes, revisionary surgery may improve the “crater deformity”. The surgery may involve the combination of peripheral liposuction around the depressed area and grafting to fill the depressed area.

Make sure that you are consulting with well experienced board certified plastic surgeons.

Best wishes.

From the pictures posted, it seems that excessive amount of tissue was taken from underneath the nipple areola resulting in scarring and depression at the nipple areola.

It will need to be correcre with the least amount of scarring. Fat graft is your best alternative and be prepared that you may need more than obe session of fat grafting to achieve the best results.