What Procedure Would You Follow to Correct my Post Op Gynecomastia Crater Deformity (Pics Included)

The fat flap may work very well in your case.  The surgery closes the crater by bringing the fat together or rotating a flap into position.  I would wait for awhile and let the swelling reduce.

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. 

Give it 6-8 months before assessing the final outcome of the surgery.  You may require fat grafting to correct any contour irregularities.  Good luck and be safe.John T.
Nguyen, MD, FACS, FICSDouble Board
Certified Plastic Surgeon

It looks like you had over resection of the central gland and not any contouring of the surrounding breast tissue. You need to wait at least 4-6 months for revision. t that time you should make sure you have an experienced Plastic surgeon who performs gynecomastia regularly do your surgery. You might get by with further contouring liposuction and ultrasonic liposuction but might need some fat grafting as well.

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, a rational and detailed surgical approach, 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 (as detailed contour correction is performed).
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.
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 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.
Secondary gynecomastia surgery patients frequently require excision of lax and 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 Onesight1,Thanks for the post and photos. Over-resection is a more difficult thing to fix than under resection. The most common procedure to fix this is fat grafting to the area. In this procedure liposuction is performed and the fat is then placed in the area that is deficient. There is a chance that one would need to undergo more than one of these procedures based on the degree of cratering, how much fat they have to harvest, and how much or little of the fat gets resorbed. I would wait until 6 months post op because at 4 weeks there is too much inflammation still occurring during the healing phase which could increase the chance that the fat will not take.Sincerely,Dr. Dadvand

Most man are just happy removing the extra breast tissue in their chests but sometimes, over-resection is possible. You should consider fat-grafting to fix the problem. Fat grafting is just liposuction followed by placement of the fat into the defect.

Sometimes patients develop a contour deformity like a donut after over resection which can happen very easily. You should probably wiat a few months for the swelling to subside. You may need to consider strattice or fat grafting to improve the contour.

Unfortunately, this is a classic example of what not to do in gynecomastia surgery...over resection. This is a much more difficult problem to solve than the opposite undesireable of under resection. This will require fat replacement either through fat injection or a dermal-fat graft. Given the size of the defect, fat injections will be more practical. The question is when to treat being just four weeks after surgery. The demarcation of the defect is fairly clear on flexing and even identifiable when relaxed. I see no benefit to waiting until the skin scars down more firmly to the pectoralis fascia. My approach would be to proceed with revisional surgery as early as six weeks after your original procedure. 

I would suggest you go to a board certified plastic surgeon to evaluate this.  I suspect a non-plastic surgeon did your surgery.  Swelling of the surrounding tissues will continue for a while, so it is too early to speculate what, if anything, you might need to correct the contour.  A divot can often be filled effectively with fat injections.  Unlike a scar within your areola, a scar on the breast skin will be more noticible, and there is nothing that will eliminate it.