We have learned so much in performing man boob surgery for more than three decades, and we love sharing with people in the forums on gynecomastia.org. We spend lots of time answering questions from guys before surgery, and we spend almost as much energy talking post-surgery patients off the ledge. Too much tissue removed? Not enough? Lopsided swelling? Lumpy scarring? All these and other post-op happenings can lead to high anxiety.
One thing that sometimes causes patients to panic is when they perceive their chest looks too flat or even concave. We can think of three main conditions that might have a guy thinking his results looks sunken.
The most likely reason a guy’s chest might seem concave is simply a perception problem. When he’s had gynecomastia a long time and then it’s gone, it’s possible the chest looks unnaturally flat or concave when it’s actually quite normal.
No gynecomastia surgeon will touch the chest muscle. We only remove excess fat and breast gland (and perhaps skin if there’s excess). If a guy’s pecs don’t have pleasing contours after healing—maybe it’s time to hit the gym? We find many patients are too embarrassed about their enlarged breasts to work out much before surgery, so it could make sense that pumping iron will help.
Rarely, we treat guys with man boobs who have an unusual ribcage configuration. One that can contribute to a concave looking chest is called pectus excavatum, in which the sternum, or breastbone, is set deeper in the chest than normal. Patients who have this condition typically know about it. If not, a plastic surgeon should point it out prior to operating so expectations will be on track.
Finally, small concave areas that mar a guy’s final results are probably crater deformities. We’re not talking about an entire sunken chest—should a patient experience such a thing it would be an enormous surgical mistake or some other problem. We haven’t seen that kind of result.
What we have seen—many times, unfortunately—are small to moderate sized indentations called crater deformities. We perform revision gynecomastia surgery dozens of times each year, and fixing craters is one of the leading reasons patients seek us out.
These depressions occur when a surgeon takes out too much tissue. We see them often under the nipple/areola complex, but not always. Cosmetic surgeons who perform male breast reduction just a few times a year may not build up the experience required to sculpt a thin, smooth layer of fat to lie between the chest muscle and skin once incisions are closed. Or they may notice a small indentation will be left behind, but think it won’t be significant.
This is one of the tricky parts of man boob surgery. In our practice, we ensure we remove all excess breast gland so it cannot become enlarged down the road. We check carefully for depressions before the end of each procedure, and if we spot one we rotate a small flap of fat into the void to compensate. So, it’s not a matter of making sure gland removal doesn’t cause a dent. It’s a matter of filling it with living tissue.
When guys with craters come see us for gynecomastia revision, we most often try to use fat flaps for the repair. Since we don’t detach the pieces completely, they survive in their new spot. If there’s not enough tissue nearby to accomplish this we can use fat injections.
If you’ve had surgery and believe your chest doesn’t look right, the best thing to do is return to your physician and talk it over. If you’d like a second opinion, we would be pleased to help. Contact us online or call 561-367-9101 to schedule an appointment.
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