Author Topic: Unhappy with my Gynecomastia Surgery results. Revision advice needed.  (Read 7272 times)

Offline stevenb

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Hello everyone,

I had my gynecomastia surgery in 2010. And things went well on the right side of my chest. But the left side has a deformity that occurs with animation. It also is still puffy and protrudes through shirts. Any advice from Dr.Bermant or anyone?

Here are some pictures. They were shot in the mirror, the left side is the one with the depression.

Both arms lifted.





Arms at side



Left arm lifted







Left side, relaxed.



Partially flexed.



Right side (looks normal), lifted.





Thanks in advance for your help!

Offline DrBermant

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Re: Unhappy with my Gynecomastia Surgery results. Revision advice needed.
« Reply #1 on: September 22, 2012, 12:28:00 PM »
Hello everyone,

I had my gynecomastia surgery in 2010. And things went well on the right side of my chest. But the left side has a deformity that occurs with animation. It also is still puffy and protrudes through shirts. Any advice from Dr.Bermant or anyone?

Here are some pictures. They were shot in the mirror, the left side is the one with the depression.

Left arm lifted



Thanks in advance for your help!

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

Welcome to our discussion group. Nice job for putting up images, but not quite there yet to define the problem fully. The lighting only shows one side. The other side is hidden and may or may not have contour issues. I evolved my Revision Gynecomastia Standard Pictures to better define such complex issues of scars, adhesion, and contour issues on animation. Both sides should be shown. There are additional flexing views to see if there are problems from the sides or oblique views. Holding the camera means the arms are not even at the same height. Read the suggestions on the page for taking the pictures. On this thread discussing How to Post Pictures in Forum I show how tripod and new software can help frame yourself in a picture with the new smartphones and cameras coupled to computers.

Even more critical than still images are my Standard Videos of the Male Chest for Contour Documentation. Other than actually being there for a clinical exam or experiencing the chest in person, that is the best I was able to make to show how good or bad any problem or result actually is. The same goes for evaluation of someone's claims for methods of managing any particular problem. Hand waving with words how great some method gets trumped with how you can see the sculpture move in real life.

Options for Revision Gynecomastia Surgery depend on the original problem, what was done, how tissues healed, what resources remain behind to rebuild, and other factors.

Complications After Gynecomastia Surgery can vary. I named several components, problems I saw from patients coming to me unhappy after surgery done by other surgeons. The issue is to define all of the components making up the particular problem, determine if there are resources to rebuild, and then demonstrate how a technique works, again best by a critical documentation system, not just a few images with hands at sides.

I coined the term Puffy Nipple Complication for a problem of scar and residual gland left behind.  I coined the term Crater Deformity, for the defects of deficient tissue, which come in many different degrees. Subtraction of an excess is fine, but it depends what surrounds this problem.

Revision Gynecomastia Surgery for Complications has limitations. Taking a hole, and making the hole bigger, is not the answer. Taking an excess in the center of a crater, and flattening the crater still does not look good.

The most powerful tool I found to solve such defects was my Fat Flap, mobilizing remaining fat wall to fill the hole. This Fat Flap had been part of my Dynamic Technique that permitted me to target gland first, and then fill the hole with the nearby fat, and then using other elements of my artist's pallet of surgical options to fine tune the contour. Sometimes the excess left in the center had to left behind. But remaining scar and gland do not move as well.

Some problems are compromise solutions such as: Revision Crater Deformity After Gynecomastia Surgery Done in Texas and Massachusetts. Some deformities that were fixable, can be converted to something without resources such as this Extended Crater Defect after Failed Revision by New York Surgeon. This last page demonstrates just how a terrible contour can be hidden with limiting what the viewer sees. When looking at only a few photos of the problem with the arms at the sides and not flexing muscles, it does not look so bad. But we do not live life that way. The videos and standard views better tell the true story.

So what can be done?

Define Current Problem
First step I used to take when analyzing such issues was to define the problem. Learning how to take a more complete set of pictures helps document the deformity and show what is going on. The process of taking and reviewing the images then can be used as a learning experience to better look at proposed solutions such as something I never saw a good result, like a fat graft. Look to see how such "solutions" look like in a more critical fashion. 

Define What Happened
This includes what was the original problem, I looked at the before surgery photos, when available. I also asked to see the operative report. What was done? Was a sharp cutting cannula, ultrasonic, Vasor, or other method used. I did not like those methods because of what I was seeing in the literature and patients coming to me for help. What happened after surgery? What was done to optimize scaring after? Are the current images what it looked like after surgery? What does the label "painful to the touch," mean? Is the discomfort a Gynecomastia Symptom of unstable gland stimulation or nerve sensitivity after surgery? If growing, critical documentation can sometimes be the key defining that the problem is not stable. For some, the gland problem was never stabilized and new growth after surgery means other issues need to be managed before considering further revision attempts. Recurrence happen.

Options For Revision Best Seen
My plan was to learn from what had happened to try not to repeat the mistakes to get a better result. I tried to put examples on my site to show solution, how they moved, and limitations of what I was able to achieve. I built a resource here How to Pick Your Gynecomastia Surgeon. In this case, looking for someone who can show how their solutions look is better than going into a revision blind based on words alone claims of expertise. While nobody can guarantee success, my results posted were typical for my practice.

Temporizing Options
Body Shaping Garments are a temporizing option offering a contour shape to exercise and participate in activities that otherwise cause embarrassment. My patients were using these Second Stage Gynecomastia Garments for their scar care, part of My Dynamic Technique. The second stage garments were initially optional. We made the garments mandatory after seeing the better results those who were using them were having. It all goes into how critically a surgeon looks at their work, evaluates the results and adapts.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
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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