55 days (almost 2 months) after gynecomastia surgery. Crater and uneven shape. (Photos)

Question

This is my condition after 55 days, crater can be seen. The right side is weird. My surgeon says it will get better with time but i habe doubts. I need your comments on my condition. Should I wait more or need some procedure to be done? Please advise on how I can improve my condition?

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  While waiting for your results to mature I would first recommend you pursue aggressive scar massage treatments and possibly low dose steroid injections into the areas of greatest scarring to try and soften the tissues.  Once your tissues have fully healed treatment options can then be considered including fat grafting and local tissue rearrangements to correct any residual deformity.  Hope this helps

Michael Law, MD · Answer

I'm  very sorry you are experiencing this.  A ‘crater’ or indentation where breast tissue has been removed generally results from a combination of over-resection of breast tissue and the formation of scar tissue (which is part of the normal healing process) which tethers and distorts the skin. Correction of this post-operative complication consists of treatment of both issues: release of scar tissue, and grafting of living tissue to fill the space and correct the indentation.
The injection of a temporary filler such as hyaluronic acid is not a practical alternative. Without releasing the scar tissue, the contour problem cannot be corrected. And injection of a hyaluronic acid filler, even if it was capable of improving the indentation, would provide only a temporary correction that would have to be repeated every few months.
Structural fat grafting can be effective at correcting some post-gynecomastia surgery contour problems, but primarily in the peripheral part of the male breast/chest area, where overly aggressive liposuction may leave surface contour irregularities. Structural fat grafting refers to the harvesting of fat from a remote location (flanks, for instance) by aspiration. The aspirated fat is centrifuged, processed and reinjected using blunt cannulas to restore a normal contour. To release scar tissue in these areas, cannulas are available with a V-shaped cutting edge which can be passed through tethering scar bands which would otherwise prevent expansion of an indented area.
In the central area of the breast, below and immediately adjacent to the areola, excess fibrous breast tissue is primarily removed by direct excision. Direct excision of fibrous breast tissue, along with the deposition of scar tissue as the surgical site heals, is what most commonly leads to indentations or ‘craters’ involving the areola, sometimes with significant distortion and irregularity of the areolar anatomy and indentations in the adjacent chest/breast skin.
The lasting correction of areolar indentations and irregularities requires experience and expertise, and at times more than one surgical procedure to achieve an aesthetically ideal appearance, so make sure that you seek treatment from a board-certified plastic surgeon who has dealt successfully with this challenging issue before. These surgical procedures generally involve the following steps, most or all of which can be accomplished through an incision or incisions at the areolar border:
1.Release of tethered skin and subcutaneous tissue by sharp dissection (scissor release or sharp cannula release).2.Levelling of any areas of soft tissue over-projection.3.Placement of solid soft tissue grafts such as dermal-fat grafts, fascial grafts and solid fat grafts (harvested from another location on the body) to restore normal surface contour to indented areas.4.Removal of any areolar skin excess contributing to surface contour irregularity.5.Structural fat grafting of associated peripheral contour irregularities.The success of solid tissues such as dermis/fat, fascia and solid fat at restoring normal contours depends upon revascularization of the grafted material. If the majority of the grafted tissue gains a new blood supply, then contour may be normalized in a single surgical procedure. Partial survival of grafted material, which in more likely for large grafts required for larger defects, may necessitate an additional surgical procedure or procedures.

Sean Doherty, MD, FACS · Answer

Based on your photos, you definitely appear to have a crater deformity. Although you are still early in your healing process, this is probably going to need some type of revision and/or scar therapy. Speak with your surgeon as to his or her thoughts but I would also encourage you to get another in person opinion from a different board certified plastic surgeon who has a lot of experience doing gynecomastia revision surgery. Best of luck.

Christopher S. Zarella, MD · Answer

I am sorry that this has been a difficult postoperative course for you.  Your surgeon is correct, however, in saying that it may continue get better with time.  While a majority of excess swelling after surgery will go down within the first three months (and many times most notably between month two and three) changes will continue to occur for 6 - 12 months postoperatively.  While you wait for the healing to continue, I would recommend aggressive massage of the surgical sites.  If the contour irregularity persists at this time point, revision surgery would be necessary, and that could range from additional liposuction (of the high areas), to peri-areolar skin excision (removing excess skin around the nipple itself in a circular fashion), to fat grafting (to fill in a depressed area, as many surgeons have mentioned below).  I understand that it is easier for me to tell you to have patience than it is if I were in your shoes, but, for now, that is going to be the most important thing.

Pramit Malhotra, MD · Answer

While I am concerned about your final outcome, in the next four months things will improve.I would recommend massage to untether the scar tissue from the areolar complex to the deeper tissues.  Things will improve some after the next 4 months although you may need additional surgery.

Daniel Brown, MD, FACS · Answer

Thanks for your questions and photos.  I'm sorry that you are going through this!  You definitely have some contour irregularities and definite asymmetry.  This may improve somewhat with time, but is unlikely to become smooth/flat, as you are already approximately 2 months out.  I would encourage you to follow up as directed with your surgeon.  You may also want to potentially seek additional consultation with an ABPS board certified plastic surgeon in your area who has expertise with gynecomastia correction to potentially explore further treatment options.

Babak Dadvand, MD · Answer

Hi,Thanks for the post and photos. At 2 months you are still in the healing process and nothing should be done until you are at least 6 months post surgery. Based purely on the photos it looks like there may be areas of overresection, swelling, as well as tethering which are causing the contour abnormalities. I recommend bringing up your concerns with your surgeon and following their advice. Sincerely,Dr. Dadvand

David E. Berman, MD (retired) · Answer

However, you will improve significantly over the next 6-12 months. i would recommend you wait 12 months before having further surgery. you will be surprised how much you will improve. i agree that massage the area for a few minutes, several times per day, will be helpful. i would be very, very cautious about injecting any steroids into the area, since steroids can cause fat atrophy which will make things worse, not better. if required after a year, you may want to consider having the tissues freed up and maybe fat grafting but give it a year and it will look a lot better than it does today.david berman md

Tarick K. Smiley, MD - Account Suspended · Answer

While I understand that you want immediate solution, take note that waiting at least six months (or until all the residual swelling has resolved and the skin has fully redraped to the final contour) is the best way to achieve predictable results from a revision surgery.

Most likely fat graft or fat transfer can correct your nipple collapse.  Nonetheless, a personal consultation with a board-certified plastic surgeon who performs primary and revision male breast reductions on a regular basis can tell you the best treatment. 
Good luck and best wishes.

Jon Ver Halen, MD, FACS (license suspended) · Answer

Hello and thank you for your excellent question. It is difficult to make a compeltely accurate assessment with seeing your immediate before and after photos. However, based on the information you have provided, I understand your concerns. I suggest that you wait at least 6 months to wait for the majority of the swelling to resolve and for the skin to tighten. If at that time you are not pleased with the results, it is possible to fat graft the breast to improve the depression. This decision should be based on a detailed discussion with equal input from both you and your surgeon. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation in person with a qualified board-certified plastic surgeon. Good luck!

Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Best,
  
Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

55 days (almost 2 months) after gynecomastia surgery. Crater and uneven shape. (Photos)

Answers (10)

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