What is causing my chest to look this 17 months post-op?

It would be very difficult to give good advise without in person consultation. Very likely, you have skin redundancy after liposuction and gland excision; skin just did not retract. Also, deep scar between skin and muscle fascia can fix the skin down to create this deformity, in particular when muscle is animated. Removal of redundant skin and deep adhesions would be something to consider based on your photos. Second opinion consult is recommended. Good luck.

Dear curious9421,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

Whenever you’re seeking an assessment on the outcome of a procedure you should always show proper before and after pictures. If you don’t have before and after pictures and ask your surgeon to forward the pictures they took. They are part of your medical records that you can request any time.
Without knowing what you look like before surgery it’s hard to make an assessment on the outcome.
It looks to me like you have substantial skin laxity and this is contributing significantly to contour.
When that’s the case a chest lift is one of the only options to get the contour correct but is a difficult procedure that not all plastic surgeons are good at and it always leaves scars.
Gynecomastia surgery is a tricky procedure and the three variables that affect the outcome are skin laxity, subcutaneous fat and glandular tissue. All of them contribute to shape and contour.
The best way to assess the fat and glandular tissue contour is to put both the skin and pectoralis muscle under tension by taking one arm at a time and stretching them behind your head while looking in the mirror or taking pictures using the timer on your camera.
With the skin and pectoralis muscle under tension you will see the contour of the glandular tissue clearly.
If it’s uneven then this reflects how the surgery was performed.
During the same maneuver of stretching your arm behind your head that you can also get a much better assessment of fat distribution and if your liposuction was done evenly or not.
I have a feeling your outcome is a combination of slightly uneven tissue removal combined with substantial skin laxity.
Perhaps the procedure could’ve been done better and you were probably not an ideal candidate for surgery not addressing the skin laxity if you wanted a better outcome.
That’s my best assessment based on limited information. If you want a proper second opinion and then schedule those is in person consultations with others board-certified plastic surgeons in your community. For a second opinion consultations come prepared with copies of your before and after pictures and a copy of your operative report.
These are all available from your previous surgeons office. They are part of your medical record that you have a right to if requested.
Best,
Mats Hagstrom MD