Author Topic: Revision Gynecomastia Surgery Forum - Fillers Fat Graft Implant or Flap to Fix?  (Read 16686 times)

Offline DrBermant

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I have terrible crater holes in my chest after gynecomastia surgery. Fat grafts, fillers, implants, or what will fix this problem. Some doctors are telling me that they can inject fat from my stomach and sides to take care of this problem.

Options for revision of Crater Deformity Scars after Gynecomastia Surgery depend on the original problem, what was done, what resources are left, after care, scar care, how the patient healed, and many other factors best explored during an evaluation.  I prefer to leave a natural layer of fat between the skin and the muscle that preserves natural motion of tissues.  When the layers scar together and there are adequate resources to revise the scars, then revision surgery may be an option.  I have revised many such deformities from other doctor's operations. Unfortunately I also have seen so many other patients where there is just nothing left to rebuild with.  A Fat Flap Gynecomastia Sculpture takes nearby fat, trying to maintain its blood supply, and filling the defect with living fat.   Fat taken from other parts of the body without a blood supply are grafts.  A good deal of such transferred fat dies and usually becomes firm.  This firm tissue can be just as firm as other scars or gland and does not look good especially on animation.  The fat flap moves like normal fat.

Firm fat, dermal fillers, and molded implants all can have values for scars, but just do not look good on tissues that are supposed to move.

I have yet to see pictures of fillers managing this defect. What I can find is inconclusive evidence.  The lighting (and sometimes the angle of) photograph changes in the before and after examples.  You can not trust the difference when the before images use lighting to accentuate shadows and deformity and the afters use lighting that hides shadows and craters.  What I have found so far also do not show how the tissues looks on animation.  Watching tissues move, as in a volleyball player's exposed chest, is proof of the effectiveness of a technique.  

Making something look good for a still picture can be a partial achievement.  It reminds me of the story of the fantastic prosthetic ear for the patient missing an ear.  It looks great until it falls off during a dinner party into a soup bowl!  Each option has its limitations.  I have never seen fat grafts used with any technique that look adequate on animation.  That includes work from those teaching such techniques at meetings.  Watching them move in person or movies tells the story to me.  The results of even the field's experts are just not something I like and so do not offer.  Our field of plastic surgery keeps on moving forward with evolution in techniques.  I am looking forward to the day that such techniques really offer a satisfactory solution.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery
Michael Bermant, MD
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Offline DrBermant

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I was just reviewing photos I have taken of fat graft complications I have removed during revision surgery on patients coming to me unhappy after having the tissue placed there by other doctors. The images I took during surgery were ugly but do not show how firm and ugly this material is: not fat like at all. The grafts are much more firm gland like which is why they do not compress like fat. Here is one such example.



That brown mess to the left is the graft, the lighter pale white like structure next to it gland scar complex. The graft had a rubber like consistency, just like gland or scar. As fat partially dies it becomes firm and not like fat at all. If it actually remained like fat, and compressed like fat, then it would be a valuable fill material and doctors using it could document with videos or flexing muscle photos. For the many patients who have come to my office unhappy after such injections done elsewhere, that was not the case.

For this patient I removed the firm mess and then mobilized near by fat filling the defect with natural soft fat.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery
Michael Bermant, MD
Retired Plastic Surgeon
Surgical Sculptor, Artist, Creative Thinker, Problem Solver
Plastic Surgery
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