Unhappy with gynecomastia surgery - what are my revision options? (photos)

Question

I had very minor gyno/mostly fatty tissue that I couldn’t keep off unless I was very skinny. I decided to have gynecomastia surgery which included lipo and I am disappointed in the results. Can you all please let me know what you think could help improve my situation? I am bothered by the puckering/tethering? Asymmetry and when I flex I can see my nipples sink down (one completely below my pec and the other seems to crease right over. Thank you all so much for your insight and advice.

Daniel Barrett, MD · Answer

Dear abbynormal1980,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Tim Neavin, MD · Answer

Thank you for your photo.  Based on the images, this can be easily improved with fat transfer.  The other good news is this can be performed under local anesthesia.  While it may take more than one session, this will get better.  There are other options that exist as well in the form of biological injectable products.  Be sure to see someone who knows how to reconstruct these (common) gynecomastia surgery deformities.

Irena Karanetz, MD · Answer

Hello,
Thank you for the question and photos.
I'm sorry to hear that you are not satisfied with your results. If you are still in the early post-operative period, I typically recommend patients to wait 6-12 months prior to undergoing revision surgery. 
Sometimes, scar release and fat grafting to the chest can help improve the depressed and tethered nipple appearance. 
I suggest that you discuss your concerns with your Plastic Surgeon.
I hope this helps.
Best regards, 
Dr. Irena KaranetzFellowship-TrainedBoard Certified Plastic Surgeon

Mats Hagstrom, MD (license on probation) · Answer

You show a lot of pictures but what we really need to see our comparative before and after pictures.

Knowing what you look like to start with has a big impact on how we assess the outcome of a procedure.

Regardless your surgeon was a little overzealous most likely in there hope to get you the best result.

Gynecomastia surgery is tricky that way.

Patients are often critical of results because they didn’t deliver enough.

Regardless you now have too much tissue removed and that is why your chest looks the way it does.

There is no easy answer to your situation and different plastic surgeons may propose different treatment options.

To me there are three ways of approaching this.

The options are.
1). Fat transfer a.k.a. fat grafting. The problem with this approach is that the area where you need the volume is now devoid of tissue to support any type of tissue graft.  This means that regardless how much fat is grafted only a small amount will survive. In order to build up enough tissue to have a clinical significance you were most likely need multiple rounds a fat transfer and this could get expensive and be beyond what patients are willing to go through.

2). Internal flaps.  With this procedure surrounding fatty tissues are separated from the skin and muscle surface and moved or rotated into the area of volume deficit.  The potential success of doing this depends on what tissues are available, the skill of the surgeon and if done incorrectly the procedure could make things worse.

3). Adding cadaver material.  There are sheets of cadaver dermis that are safe for implantation to create tissue barriers.  it’s basically cadaver skin that has had all DNA containing cells removed and what’s left is pure collagen Scaffolding.  there are multiple names of the product depending on who is the manufacture. AlloDerm is one of the better known and earlier created brands. These products allow in growth of the recipients own tissue.  It may create a firm lump with excessive scar information or give a partial improvement. The product can be folded and shaped to some degree.

In the end there is no easy answer to treat someone who is head too much tissue removed in an attempt to get anesthetic improvement.

Liposuction is in many ways permanent and irreversible.

In your case it was most likely an open excision of glandular tissue that was overly aggressive but I wasn’t there for the procedure.

If you want to move forward and I willing to put up with partial improvements then start having in person consultations with local board-certified plastic surgeons I’ll see what each one has to say.

These are simply my thoughts and others will have different ideas and may have more first-hand experience or skills that I don’t.

I would be a little cautious on anyone who claims to have a simple fix they will make it perfect with a single procedure.

I’m sorry this happened to you.

For what it’s worth you look super fit and your physical appearance is stellar.

Best,

Mats Hagstrom MD

David E. Berman, MD (retired) · Answer

if your surgery was less than 6 months ago, you may find that the situation improves with time and you just doing some self massage over the scarred area (1-2 minutes 3 times per day is enough). if it seems like it is improving then keep waiting, even for 12 months. If it has been close to a year with no improvement, then you can consider fat transfers since you were over-resected, which can happen, even in the best of hands. One round of fat grafting may be do the trick, but it is possible that you may need a second session 3 months after the first one, since at least 25-50% of the fat will be lost.

david berman md, frcsc

david berman md, frcsc

Unhappy with gynecomastia surgery - what are my revision options? (photos)

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