Gynecomastia revision, 12 years post op - minimally invasive procedure to untether the skin? (photos)

Question

The skin has adhered to the underlying muscle tissue at the location of the semicircular incision and I wanted to know if there is a minimally invasive procedure to untether the skin, remove the adhesions and complete a fat graft without redoing a semi-circular incision. For example, is the Taylor Liberator Subcision approach (a technique that utilizes a small device to remove tethered scars in the face) possible in my scenario? By the way, I'm twelve years post op. Thank you!

Zoran Potparic, MD · Answer

Release of deep adhesions can be done in different ways using an small incision for placement of special fork cannula or a small blade. Fat grafting of the area should follow. However, it is unpredictable whether all of this will address asymmetry of areolas and expand smaller areola sufficiently. Open approach would give a better chance to address that issue? Good luck.

James Knoetgen, III, MD · Answer

Gynecomastia revision surgery aims to address issues that may arise years after the initial procedure, such as tethered or adhered skin. Minimally invasive procedures for untethering the skin can provide a solution with reduced recovery time and less scarring. Here are some options and considerations for such a procedure 12 years post-op:
1. Scar Tissue Release
•	Subcision: A needle or cannula is inserted under the skin to cut the fibrous bands causing tethering, allowing the skin to release and smooth out.
•	Radiofrequency-Assisted Lipolysis (RFAL): Techniques like BodyTite use radiofrequency energy to heat the tissue, breaking down scar tissue and promoting skin tightening.
2. Liposuction
•	Ultrasound-Assisted Liposuction (UAL): Uses ultrasound energy to break up scar tissue before suctioning out the fat, helping to release the skin.
•	Laser-Assisted Liposuction (SmartLipo): A laser fiber melts fat and releases tethered areas while tightening the skin.
3. Fat Grafting
•	Autologous Fat Transfer: Fat is harvested from another part of the body and injected into the tethered area to smooth out contour irregularities and provide volume.
4. Minimally Invasive Skin Tightening
•	Radiofrequency Microneedling: Combines microneedling with radiofrequency energy to break up scar tissue and stimulate collagen production for smoother skin.
•	Thermage or Ultherapy: Non-invasive treatments using radiofrequency or ultrasound energy to tighten the skin and improve elasticity, potentially reducing the appearance of tethering.
5. Consultation and Customization
•	Plastic Surgeon Consultation: A consultation with a board-certified plastic surgeon specializing in gynecomastia revision is crucial. The plastic surgeon can assess the extent of tethering, skin quality, and other factors to recommend the most suitable minimally invasive option.
•	Customized Treatment Plan: Based on the assessment, a plan can be developed to achieve the best possible outcome with minimal downtime.
6. Post-Procedure Care
•	Compression Garments: Wearing compression garments as recommended by the plastic surgeon to help with swelling and support the new contour.
•	Follow-Up Visits: Regular follow-up appointments to monitor healing and address any concerns promptly.
These procedures aim to address tethered skin with minimal invasiveness, promoting a smoother and more natural appearance. Consulting with an experienced plastic surgeon will provide the best guidance tailored to individual needs and conditions.

Darryl J. Blinski, MD · Answer

Based on the posted photo a local anesthesia option would be sub and dermal fat grafting down site groin with bolster dressing to fill the indentation of the previous surgery. Expect me to arrange from $3000-$5000. Best of virtual consult with.

Mats Hagstrom, MD (license on probation) · Answer

I’m afraid the chance of having a high-quality outcome from revision surgery is quite low.
Releasing scar tissue will simply create more scar tissue.
You can’t release the tethering without it simply returning.
Fat transfer is unlikely to be effective because the area is now devoid of sufficient host tissue to support the grafted fat.
 When all the subcutaneous tissue has been removed and a patient is left with skin on muscle. There is no tissue to graft fat into. 
If you release the scar tissue, then try to inject fat. I’m afraid all of that injected fat will probably die.
This will in turn simply lead to more scar tissue.
Fat transfer works the least in areas you need the most.
My best recommendation is to find the most experienced plastic surgeons. And the hands of sufficiently experienced providers it should be clear how difficult the situation is, and you should be guided to accepting the fact that a high-quality outcome with a single round of revision surgery is unlikely to give you the result you’re hoping for.
Weather trying to improve the outcome is worth it or not is a private discussion that needs to be had between each provider and their patient.
The chance of you having a quality outcome from a single round of fat transfer with her without release of scar tissue is in my opinion fairly unlikely.
The outcome of your previous procedure is unfortunate.
Before undertaking any surgical procedure, I recommend patients ask providers to show examples of previous cases done to get an understanding of what you can expect and to get an understanding of the providers previous experience with similar situations.
Personally, I’ve tried this enough times to not feel like putting patients through unsuccessful surgery again.
I wish I could be more optimistic, but believe patients deserve to hear the truth.
I think anyone who is optimistic about correcting your outcome may be lacking experience.
All the very best,
Mats Hagstrom MD

Gynecomastia revision, 12 years post op - minimally invasive procedure to untether the skin? (photos)

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