Gynecomastia Forum, Doctor and Surgery Resources

General => Gynecomastia Talk => Topic started by: impervious on October 12, 2008, 02:05:54 PM

Title: Question For Doctors: Preventing Creasing, Crater and Scars
Post by: impervious on October 12, 2008, 02:05:54 PM
Doctors,  I cannot help but notice several threads where patients are unhappy about scars, craters or creasing that leaves "deformities."

In most cases, these patients have gone to very reputable doctors who perform hundreds of these procedures where one would NOT expect this to happen. As the surgeon, what steps do you take to prevent such deformities from occurring?

What variables affect these occurrences? In other words, does it depend on your particular condition? For example, my surgery will be done through incision and lypo from the same incision. Does this increase my possibility for the deformities mentioned above? Thank you!

Title: Re: Question For Doctors: Preventing Creasing, Crater and Scars
Post by: George Pope, M.D. on October 12, 2008, 05:59:02 PM
A classic crater deformity results from excess tissue removal, whether it's from lipo or direct tissue excision.  It's important to leave enough tissue support beneath the nipple/areola area so the skin there doesn't collapse, but it's usually gland tissue that has to be left (the tissue immediately under the nipple/areola skin).  You take out too much: crater deformity.  You leave to much: persistent puffy nipple.  So you walk a fine line here.  I hope that makes sense.

As for preop exercise (your other thread), just eat well, stay hydrated, and get plenty of sleep as you approach your surgery date.  Vitamins (either in food or supplements) are important for proper wound healing.

Good luck with your surgery; already scheduled?

Dr. Pope, M.D.
Title: Re: Question For Doctors: Preventing Creasing, Crater and Scars
Post by: DrBermant on October 12, 2008, 06:18:48 PM
Doctors,  I cannot help but notice several threads where patients are unhappy about scars, craters or creasing that leaves "deformities."

In most cases, these patients have gone to very reputable doctors who perform hundreds of these procedures where one would NOT expect this to happen. As the surgeon, what steps do you take to prevent such deformities from occurring?

What variables affect these occurrences? In other words, does it depend on your particular condition? For example, my surgery will be done through incision and lypo from the same incision. Does this increase my possibility for the deformities mentioned above? Thank you!

All surgery results in scars, it is really a question on how to minimize such scars and help the tissue look good both at rest and in animation.

Creases typically is the result of extra skin just not being able to shrink enough. How well Excess Skin of the Male Chest (http://www.plasticsurgery4u.com/procedure_folder/male_breast/gynecomastia_excess_skin.html) contracts, depends on how much loose skin is there, how much tissue is removed, surgical technique, the quality of the skin, and many other factors.  One option is to cut out the excess skin such as with a Skin Reduction Chest Lift (http://www.plasticsurgery4u.com/procedure_folder/male_breast_lift/skin_reduction_chest_lift.htm) for a patient after massive weight loss. However, this entails a scar compromise.  Other times it is better to permit the skin to shrink on its own.  When it does not shrink enough, a skin crease can be the result.

Crater Deformity Complication after Gynecomastia Surgery (http://www.plasticsurgery4u.com/revision_gynecomastia/crater_complication_scar.htm) can be from excessive removal, scarring, and many other factors.  With my Dynamic Technique Gynecomastia Surgery (http://www.plasticsurgery4u.com/procedure_folder/male_breast/chest_dynamic_sculpture.html), I prefer to target the gland first and NOT leave a shelf of gland behind.  I see many patients coming to me for revisions for after other surgeons' use of that method not liking residual puffy nipples.  My Fat Flap Sculpture (http://www.plasticsurgery4u.com/procedure_folder/male_breast/fat_flap_sculpture.html) permits me to support the areola and nipple with fat instead of remaining gland.

The many results on my website are typical for my patients.  To achieve these results I push the envelope using many different elements to optimize the sculpture of each patient.  Patient education is also important for realistic expectations.  That is why I have such an extensive website for this problem.

Hope this helps,

Michael Bermant, MD
Learn More About
Gynecomastia and Male Breast Reduction (http://www.plasticsurgery4u.com/procedure_folder/male_breast/index.html)
Title: Re: Question For Doctors: Preventing Creasing, Crater and Scars
Post by: sergeantpepper on October 13, 2008, 08:16:53 PM
Damn I wonder if my crease is a result of too much gland removed, or if my skin is just bad. I dont have a crater though. would skin collapsing always appear as a crater?
Title: Re: Question For Doctors: Preventing Creasing, Crater and Scars
Post by: DrBermant on December 02, 2008, 08:59:39 AM
Damn I wonder if my crease is a result of too much gland removed, or if my skin is just bad. I dont have a crater though. would skin collapsing always appear as a crater?

Putting up Standard After Gynecomastia Surgery Pictures (http://www.plasticsurgery4u.com/revision_gynecomastia/chest_revision_pictures.htm) can help others better understand your concerns.

Yes as mentioned in my post above, there can be many factors that contribute to the chest contour after surgery.

Hope this helps,

Michael Bermant, MD
Learn More About
Gynecomastia and Male Breast Reduction (http://www.plasticsurgery4u.com/procedure_folder/male_breast/index.html)
Title: Re: Question For Doctors: Preventing Creasing, Crater and Scars
Post by: Grandpa Bambu on December 02, 2008, 04:16:59 PM
Dr. Pope is right, they walk a fine line. But given the choice I'd rather have a flat chest with crater deformity than a gyno chest. At least with crater deformity you can still walk around in a T-shirt and not get laughed at.

Yeah, that's the ticket....  ;)

GB