Why is Fat Recommended to Correct Crater Deformity?

Question

I'm wondering if a fat transfer (or fat "flaps" or "graft implant") will provide the necessary firmness and support beneath the areola that the gland normally provides. I'm a thin 43 yr old male, with a crater deformity left from a surgery I had as a teen (28 yrs ago) to remove the glands that caused me to have puffy nipples for more than a year. I've regretted having the surgery ever since, and as I have aged the deformity has become more pronounced. Any advice would be helpful. Thanks!

Vivek Bansal, MD · Answer

If you are thin, getting quality fat for the grafting becomes a concern. Find a Board Certified Plastic Surgeon to assess you and offer alternatives. Thank you for your question and good luck with everything.

William Bruno, MD · Answer

Based on your photos, a fat transfer (graft) should fill in this area and restore a more natural chest contour. A certain percentage of the fat will not survive, so we typically overcorrect with the fat graft, anticipating about a 20-30% shrinkage of the fat.  If the fat is harvested and handled carefully, most patients can do quite well with this technique.Consult with a board certified plastic surgeon for a complete evaluation.

	Best wishes,

	Dr.Bruno

Matthew Schulman, MD · Answer

Gynecomastia surgery removes excess male breast tissue. Unfortunately, over-resection can cause a concavity or divot under the areola such as in your case. I agree that the treatment includes release of the scar tissue and placement of a dermal fat graft. This graft can be taken from an area on your abdomen and is used to "fill the space" beneath the nipple. Fat injections are also a possible solution but may not stay in place as well as a graft. Obviously, a formal evaluation with a board certified plastic surgeon is necessary.

Peter A. Aldea, MD · Answer

The depression you are referring to is the combination of over-resection of the breast gland and fat combined with scar pulling of the skin into the defect. Some refer to it as a "Shot Glass Deformity".

	The correction needs to involve a reversal of the pathology - dividing the scar pull of the skin down and adding VOLUME / FILL under the depressed area of the areola. The best filler bar none is your own fat. You will need one or more procedures in which scar bands are cut with a special needle and fat harvested from another area of the body is grafted under the depression. Not all the fat is apt to survive and as a result more may bed needed but in the long term nothing is as good as replacing the missing tissue in kind.

	Peter A Aldea, MD

Erez Sternberg, MD · Answer

This can be a very difficult problem to fix. I would recommend that you have a formal evaluaton with a plastic surgeon to address this issue.  You will likely need some scar release under the areola and then fat grafting to fill in the tisue defect. 
Be aware that this may require a second procedure to get things just right. Good luck!

Samir Shureih, MD · Answer

This deformity is best treated with fat graft. It can be treated with flaps, redistribution of local tissue. This is a very delicate issue and needs an expert

	Consult a BOARD CERTIFIED PLASTIC SURGEON ( AMERICAN BOARD OF PLASTIC SURGERY), and you will need one to two surgeries to correct.

Mary Lee Peters, MD (retired) · Answer

Dear Bret,

	Fat transfers (also known as liposculpture, lipotransfer, and fat grafting) works well in your setting.  At the time of your gynecomastia repair, too much tissue was removed under the nipple.  Removal of fat from another part of your body and replacement into the area of indentation can be very successful, particularly because the chesrt has a good blood supply for the transferred fat to be nourished by.  It is possible that it may require more than one procedure, but is well worth pursuing.

Why is Fat Recommended to Correct Crater Deformity?

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