Just the other day we answered a question on gynecomastia.org about the occurrence of sunken chests and inverted nipples after gynecomastia surgery. We told the poster this should be a very rare problem, but if you browse the forums on gynecomastia.org, you’ll find otherwise. One of the leading (if not THE leading) complications guys talk about following surgery is sunken areas that range from small dips to large valleys.
Depending on the size and location, these problem areas are either called crater deformities or irregular contours. Unfortunately, there are no statistics and no formal studies of the condition we’re aware of. But we hear about them online many times and fix several annually for men who choose us for revision gynecomastia surgery..
If you’re unhappy with the results of your procedure, it’s a reasonable bet that a sunken area is a problem you’re familiar with, whether one of your nipples is cratered or you have a larger depression. It’s another good bet that your surgeon doesn’t have extensive experience in gynecomastia surgery.
In our gynecomastia practice these problems almost never occur. But in the hands of an inexperienced surgeon, it can be another matter. Some are too aggressive in removing tissue and don’t recognize that the skin won’t lie smoothly over the chest after surgery. Others try to contour the chest with liposuction only, leaving areas that are too thick and/or too thin.
The guy who posted the question about sunken chests recently also asked whether a bad result can depend on how much tissue needs to be removed. Our answer is no, it shouldn’t. An expert gynecomastia surgeon should be able to remove huge amounts of gland and fat from guys with pendulous breasts without creating irregularities. It’s just as challenging, however, to remove a tiny amount of breast gland from a bodybuilder or athlete with no excess fat. These cases are ones that can result in a cratered nipple.
No, it’s not about removing tissue and creating depressions. It’s about addressing potential low spots while the patient is still on the operating table. If we remove enough breast gland to create a possible depression, we’ll rotate a nearby “tongue” of fat, with its blood supply intact, into the spot to smooth things out. And we almost always use our own slim cannula (sometimes with the suction turned off) to make sure we leave an even, thin layer of fat on top of the chest muscle. Finally, sweeping the cannula gently between the skin and fat allows the skin to re-drape and lie smooth after healing.
Dozens of prospective patients come through our doors seeking gynecomastia revision in greater Miami each year. The problem is often craters and valleys, and most of the time we can improve the results of an inexperienced surgeon. We may perform light liposuction to even out fatty areas and make valleys less noticeable. Very often, we’ll utilize the fat flaps mentioned above to fill a crater or small depression. Sometimes, fat grafting using tissue harvested from the abdomen or love handles is the best choice. Whatever surgical plan is best for a patient, we stress that we are confident we can make his results look “much better,” not perfect.
In any case, there’s no better application for the old saying, “an ounce of prevention is worth a pound of cure” than this one. Crater deformities and irregular contours should be avoided rather than fixed in a second operation. During consultations with guys considering gynecomastia surgery, we try to impress upon them the necessity of choosing a board certified plastic surgeon with hundreds, if not thousands, of successful man boob surgeries to their credit. Getting it right the first time should be the goal: the best way to prevent a crater deformity is to choose your doctor wisely.
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