What can I do if my doctor declines a revision request? (Photo)

Question

In May I will be 6 months post op from Gynecomastia surgery. I’m less than happy with the results, I have cratering on both sides under the areola which is causing it to fold into itself when flexing ever so slightly and unflexed there is a crease running through the middle. I brought this up to my doctor at the 3 month check up and he said it’s normal and it won’t get better because nothings wrong. What should I do?

Tim Neavin, MD · Answer

Thank you for your photos.  When you lift your arm there is a slight indentation.   Is it evident when your arms or down?   It is possible the areola scarred down to the muscle.  I would recommend massaging the area several times a day to try to break up scar tissue.  If it remains, one option would be to inject fat under the tissue.  Be sure to see someone who has a lot of experience with fat transfer.

Daniel Barrett, MD · Answer

Dear Gorgeous397096,
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

Leland Webb, MD · Answer

While revisions are not entirely common, sometimes they are reasonable to do. If your surgeon is unwilling to provide a revision, then you could seek a second opinion. Given the pictures you provided and your symptoms, there are some options for you which include possibly Fat grafting. Understand, however, that this brings tissue back to the area that tissue was originally removed. The goal in this case would be to improve the cratering that you are experiencing. This can be a common result from this type of surgery. However, if it is a scenario that bothers you, know that you do have some options, moving forward, however, it sounds like it might be with a new surgeon. We are happy to help in any way we can.

Sanjib Tripathee, MD · Answer

Your result are good actually. The NAC complex might be moving inward because of attachment to underlying muscle. Daily massage of NAC might help to release the attachment and give a better look.

Arian Mowlavi, MD, FACS (license on probation) · Answer

You can correct cratering of the nipple and areola with a simple fat transfer that can be done under local anesthesia. Please consider a virtual consultation with a high definition body contouring provider.

Mats Hagstrom, MD (license on probation) · Answer

Revision policies should be discussed before surgery during in person consultations. Plastic surgeons are not obligated to do revisions especially if they feel it is not indicated.

When that’s the case your options are to get second opinions from other plastic surgeons and start the process again.

In the end each plastic surgeon is responsible for the outcome of their procedure and each patient likewise is responsible for choosing the plastic surgeon they did.

Different plastic surgeons have different levels of skill and experience as well as willingness to do revision surgery.

Most patients are not aware of how plastic surgeons need to be screened or vetted during consultations or how difficult it is to find the most experienced and talented provider in your community.

My basic recommendation is to have as many in person consultations as possible. During consultations ask every provider to show their entire collection of before and after pictures. Seeing a handful of representative best of their career results is insufficient to get an understanding of what average results look like or how many procedures that provider has performed.

An experienced provider should have no difficulty showing you 50 or more sets of before and after pictures.  ask the provider to show ideal outcomes average outcomes and less than outcomes during the consultation.

Highly experienced providers will have many more before and after pictures than that.

Lastly I recommend reading all the reviews on various physician review websites avoiding providers with any significant number of justified negative reviews.

The absence of justified negative reviews is more important and more telling in surgeon selection than those who have an abundance of positive reviews.

Gynecomastia surgery isn’t the easiest procedure to do to get home runs every time and it’s a balancing act between delivering enough results and not having the procedure look like it’s over treated.

Well getting an assessment for the outcome of a procedure you always need to show a proper before and after pictures. If you don’t have those ask your surgeon to forward the ones they took. If you seek proper second opinion consultations from other providers you should also get a copy of your operative report.

Good luck,

Mats Hagstrom MD

What can I do if my doctor declines a revision request? (Photo)

Answers (6)