Author Topic: Need Advice Please Help!  (Read 11683 times)

Offline gatorman

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Need Advice Please Help!
« on: April 29, 2012, 06:14:45 PM »
Hello everyone & hope all is well with all of you,

I had a gynecomastia surgery 5 months ago to treat puffy nipples. I don't like the results because the surgeon created craters and now my nipples look slightly puffy with craters at the same time!! The crater on the left side is deeper than that on the right but at the same time the lump on the right side after surgery is bigger. the doctor says the lump is just a scar tissue, although I think it's residual gland since I had symmetrical glands (I did a mammogram before the surgery). In addition, I don't see any shrinkage in the areola size and the doctor blames it on my skin (I'm 5 ft 11.25 & 160 lbs so I don't think I should have a skin tightening problem). The nipples looked round before surgery but now they look oval shaped and the left nipple is not healing as the right one because the cut was made in the nipple not under it.

The doctor told me that he can do fat grafting to fix the problems but after I read Dr. Bermant's opinion about grafting and fat flaps, I became reluctant to do the grafting and told my doctor that I prefer fat flaps but he didn’t agree that flaps are a better solution. Also, I don’t see any nipple definition after the surgery and by that I mean the nipples look like they don’t belong there and they are not sticking out like normal but rather are sucked in. I also want to make sure that the lump on the right side is not a residual gland because it’s far bigger than the one on the left side.

Sorry everyone for writing all of this, but I’m depressed and in dire need of help. I would like to know if there is a very skilled doctor that I could go to in Florida. I’m a student and I live in Florida, so I can’t afford to travel to other States. I need a name or names of good doctors because I don’t want to ruin my chest by doing a revision with my original doctor because I don’t think he knows what he’s doing. The doctor says my results are within the norm, but I think not (they don't look terrible but still not the result I would take off my shirt to show off with)

Sorry but I don't know how to attach photos.

Thank you all.

Offline DrBermant

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Re: Need Advice Please Help!
« Reply #1 on: April 30, 2012, 01:53:30 AM »
Hello everyone & hope all is well with all of you,

I had a gynecomastia surgery 5 months ago to treat puffy nipples. I don't like the results because the surgeon created craters and now my nipples look slightly puffy with craters at the same time!! The crater on the left side is deeper than that on the right but at the same time the lump on the right side after surgery is bigger. the doctor says the lump is just a scar tissue, although I think it's residual gland since I had symmetrical glands (I did a mammogram before the surgery). In addition, I don't see any shrinkage in the areola size and the doctor blames it on my skin (I'm 5 ft 11.25 & 160 lbs so I don't think I should have a skin tightening problem). The nipples looked round before surgery but now they look oval shaped and the left nipple is not healing as the right one because the cut was made in the nipple not under it.

The doctor told me that he can do fat grafting to fix the problems but after I read Dr. Bermant's opinion about grafting and fat flaps, I became reluctant to do the grafting and told my doctor that I prefer fat flaps but he didn’t agree that flaps are a better solution. Also, I don’t see any nipple definition after the surgery and by that I mean the nipples look like they don’t belong there and they are not sticking out like normal but rather are sucked in. I also want to make sure that the lump on the right side is not a residual gland because it’s far bigger than the one on the left side.

Sorry everyone for writing all of this, but I’m depressed and in dire need of help. I would like to know if there is a very skilled doctor that I could go to in Florida. I’m a student and I live in Florida, so I can’t afford to travel to other States. I need a name or names of good doctors because I don’t want to ruin my chest by doing a revision with my original doctor because I don’t think he knows what he’s doing. The doctor says my results are within the norm, but I think not (they don't look terrible but still not the result I would take off my shirt to show off with)

Sorry but I don't know how to attach photos.

Thank you all.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Welcome to our forum. There can be a great deal of Emotion Living with Gynecomastia. I saw many patients who were unhappy after other doctors surgeries that I coined a number of phrases to define some of the complications.

The Crater Deformity is a defect that just does not look good and I saw many different degrees, only a few of which I have posted to date on the site. The Puffy Nipple Complication also came in many different forms. Yes, I did see patients with combined deformities and other variations.

Here is a Guide to Posting Pictures Here on the Forum.

Firm remaining tissues can be gland or scar. Both can deform tissues. That is why I preferred techniques to target gland first and minimize scarring.

Sometimes scars can be moved to the edge of the areola as I did during my Revision Gynecomastia for Patient Unhappy After NY Surgery.

We have resources here about How to Pick Your Gynecomastia Surgeon. We saw many  Gynecomastia Patients from Florida and around the world who told me that they regretted not having traveled for their surgery. Revision surgery is more complex and some problems can be so bad, that I was not able to offer revision options such as this Failed Extended Crater from Revision Surgery by New York Surgeon.

I have discussed Revision Gynecomastia Surgery Forum - Fillers Fat Graft Implant or Flap to Fix? on that post and elsewhere. I have yet to see a good looking fat graft that moved well on a male chest. Yes, in my opinion, the chest should look good while living life, not just in a few photos with limited views. It is hard to play sports with hands at the sides not flexing muscles. If a surgeon has a method that works, then you should be able to ask to see examples with critical documentation.

Hope this helps,

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

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Re: Need Advice Please Help!
« Reply #2 on: April 30, 2012, 05:46:38 PM »
Thank you very much Dr. Bermant for your prompt response and explanations. All your comments made sense and now I have some understanding of the situation. You are retired now which is a good thing for you but bad for us :) and that would make it even more difficult to find a surgeon as talented and experienced as you. Your guide for finding a good plastic surgeon is very useful but it would take me a lot of time to visit plastic surgeons and then apply the guidelines on each one of them especially if I'm going to travel from one place to another. I was hopeful to get names but I can understand why you can't mention specific names. The surgeon I went to is a "board certified plastic surgeon" and he assured me that everything will be fine, but it turned out to be the opposite; so it's a gamble each time you go to a surgeon even if they are a board certified plastic surgeon.

I'm thinking of not doing anything at all to my chest and guess I'll have to live with it like I did with the gynecomastia because I think I did enough damage already and can't risk being butchered by another "Board Certified" plastic surgeon.


Thank you very much again Dr. Bermant and hope you enjoy your retirement, and please tour the country and have fun :) come to Florida :)

Offline DrBermant

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Re: Need Advice Please Help!
« Reply #3 on: April 30, 2012, 09:41:38 PM »
Thank you very much Dr. Bermant for your prompt response and explanations. All your comments made sense and now I have some understanding of the situation. You are retired now which is a good thing for you but bad for us :) and that would make it even more difficult to find a surgeon as talented and experienced as you. Your guide for finding a good plastic surgeon is very useful but it would take me a lot of time to visit plastic surgeons and then apply the guidelines on each one of them especially if I'm going to travel from one place to another. I was hopeful to get names but I can understand why you can't mention specific names. The surgeon I went to is a "board certified plastic surgeon" and he assured me that everything will be fine, but it turned out to be the opposite; so it's a gamble each time you go to a surgeon even if they are a board certified plastic surgeon.

I'm thinking of not doing anything at all to my chest and guess I'll have to live with it like I did with the gynecomastia because I think I did enough damage already and can't risk being butchered by another "Board Certified" plastic surgeon.


Thank you very much again Dr. Bermant and hope you enjoy your retirement, and please tour the country and have fun :) come to Florida :)

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Thank you for your kind words. Posting pictures has great power and can help with education of yourself and others.

Learning How To Evaluate Gynecomastia Pictures is key when trying to evaluate the skills of a surgeon before traveling to see any doctor. My patients usually came to me only after an extended discussion by phone and sending me images such that travel could be minimized. That was part of our Preliminary Remote Discussion.

I posted an extensive set of standard pictures and videos to show typical results for my patients. When surgeons choose to share their skill levels in this fashion, it empowers the public with choice to see travel to see doctors for their care. The problem comes when doctors limit what they share, posting limited views and not showing how tissues move. If the public demands to see more and learn more, better doctors should be able to use these methods to attract patients seeking those skills.

It becomes a gamble when patients choose doctors without looking for such documentation. It takes more than just Board Certification in the process of Picking a Plastic Surgeon. The question becomes what type of research does any patient perform?  What steps did you do, what did you skip, what of our guidelines could be improved?

Sometimes posting pictures after surgery, in forums such as this one, is a way to share just what a surgeon results were like. This can be a factor when the surgeon has no examples for others to see or if the results do not look like what a patient was shown before surgery. Sometimes the pictures show good results and the patient has unrealistic expectations. Critical documentation was how I learned how to improve my own techniques. That is a tool I learned from my mentors and something I have been advocating for many years.

Of course the other option would be:

Quote
I'll have to live with it

but then what about the next patient, and did this forum offer enough for your education to let you move on?

Hope this helps,

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

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Re: Need Advice Please Help!
« Reply #4 on: May 01, 2012, 02:02:25 AM »
Here are the pics & sorry for the bad quality. I'm still using a scar gel hope it doesn't get in the way too.

Here you can see both nipples did not shrink and look dead


right nipple


right nipple stretched


left nipple


left nipple stretched



left nipple when flexed


let me know what you think.
« Last Edit: May 02, 2012, 02:28:29 PM by gatorman »

Offline DrBermant

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Re: Need Advice Please Help!
« Reply #5 on: May 02, 2012, 02:21:37 PM »
Here are the pics & sorry for the bad quality. I'm still using a scar gel hope it doesn't get in the way too.

Here you can see both nipples did not shrink and look dead


right nipple


right nipple stretched


left nipple


left nipple stretched



left nipple when flexed


let me know what you think.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Thank you for sharing your photos. The gel is not an issue, but missing standard views hides the degree of contour. Limited views tell only part of the story. My Standard Pictures For Gynecomastia Revision Surgery were designed to be more complete. Additional views are nice, but the basic ones are all part of establishing contour issues. There is a check list I designed to make it easier.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery
[/quote]
Michael Bermant, MD
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Surgical Sculptor, Artist, Creative Thinker, Problem Solver
Plastic Surgery
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Offline gatorman

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Re: Need Advice Please Help!
« Reply #6 on: May 03, 2012, 07:28:32 PM »
Thank you Dr. Bermant for your help & I'll try to post the pics as you requested.

Thanks again & Good luck.