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About fat flap

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About fat flap
« on: February 17, 2015, 07:28:17 AM »
Hi, I had my surgery 8 months ago, sadly things didnt work out as expected. I ended up with puffy nipples in both sides, got 1 session of kenalog shots in the left side, and 4 sessions in the right side. I still have puffy nipples and I already accepted myself that I would need a revision surgery to remove the remaining gland/scar tissue. But also in the right side appears to be a small crater around the nipple, it is not that bad but I think it can be improve. It isnt under the nipple, is around it. I will attach a drawing in paint to give an idea.

My question is: Can it be enough resources around the pec to perform a fat flap? How far away does the fat has to be in order to perform the fat flap?

It is not that bad and I believed by flattering the puffy nipple in the revision surgery will help with the contour, but correcting the crease also will definitely help to make it look better.

About the surgery: The surgeon made 2 incisions inside the nipples in each nipple, one above the tip and the other below the tip. And did the liposuction in the side not that far away from the nipple.
The chest look pretty flat after surgery, also I used the vest 24/7.
2 weeks post op everything seemed OK and flat. And the surgeon suggested Ultrasound Cavitation and Ultrasound Therapy (Which he also charged a "nice" fee  :-\ it wasnt cheap  :-[) but anyways I thought whatever helps with the recovery i'm in, even though I was healing great.
So I had 3 sessions in my 3rd week, I felt that my chest was being punished and just had surgery in it, didnt want it to touch it, and moving that thing of the ultrasound around my chest didnt feel good specially in the nipples. and by the 2nd session I felt that something was building on, and by the end of the week and beginning of 4th week post op, some serious scar tissue was building up. I got kenalog shot 3.5 - 4 months post op.

I wont lie, it has been REALLY tough all this months, specially mentally speaking. It took me years to save the money for the surgery and to finally get rid of my gyno (puffy nipples) and I FAILED.

Any advice or comment would really help, I really appreciate the help this community has build. I discover it after my surgery and helped me throughout my recovery. Had my surgery when I was 19 yrs old, today im 20.
Thank you for reading.

Linkback: https://www.gynecomastia.org/smf/index.php?topic=30237.0

Re: About fat flap
« Reply #1 on: February 17, 2015, 09:01:43 PM »
So sorry to hear about your disappointment.

All is not lost, however. Revision might be helpful.  I have revised almost 300 cases and have always found enough surrounding fat so that fat flaps could be used for the reconstruction.  However, every revision case is unique and comes with its own set of imperfections, which have to be discussed with honesty and candor with your surgeon.  You must also be realistic in accepting that revision surgery is playing catch-up and that improvement, not perfection, should be the goal.

I have written about revision surgery and would suggest you read about it -- the url is available under my signature.  I trust the information will be helpful to you.

Good luck!

Dr Jacobs
Dr. Jacobs 
Certified: American Board of Plastic Surgery
Fellow: American College of Surgeons
Practice sub-specialty in Gynecomastia Surgery
815 Park Avenue
New York, New York 10021
Telephone:  (212) 570-6080
Email:  dr.j@elliotjacobsmd.com
Website:  http://www.gynecomastiasurgery.com
Website:  http://www.gynecomastianewyork.com/revi

Re: About fat flap
« Reply #2 on: February 18, 2015, 03:54:24 PM »
Photos in situations like this are always helpful. Its a bit unusual to have 2 incisions inside each nipple. At 2 weeks there is always a lot of swelling so the fact that you looked ok at that point is not atypical.As the swelling from the procedure goes down you can increasingly notice any potential shortcomings so to speak of the surgery.Significant revisions are always disappointing.There is a lot that can be done so you should look at that as a positive. What needs to be done at this point is dependant on what was already done and how you have healed form the surgery.
Jay M. Pensler,M.D.
680 North Lake Shore Drive
suite 1125
Chicago,Illinois 60611
(312) 642-7777

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