one of the issues we seek to avoid in gynecomastia surgery is the crater deformity. This is when the gland is removed, and the resultant areola sinks below the surrounding skin since there is no underlying fat. Note that perfect contour is not always achievable, there are always minor contour issues after surgery, but if they are kept minor, they won’t detract from the results of surgery.
There are two strategies that surgeons employ when doing a primary surgery to avoid the crater deformity.
strategy one: (not recommended by me): leaving a piece of gland behind that is roughly the same thickness as the surrounding skin. This will avoid the sinking look, but will leave gland behind that does predispose some patients to recurrence. That said, this strategy is fairly popular with those that don’t do a lot of gynecomastia surgery.
strategy two: (that’s the one we employ) is to preserve all normal surrounding fat around the areola and then move the surrounding fat via a fat flap to reposition and cushion the areola.
example of crate deformity: This young man had gland excision, which was complete, but the surgeon did not employ fat flaps, leaving a crater deformity.
Solution for crater deformities/indentation after gyno surgery:
there are three solutions that I employ to try to correct these after surgery
Solution one: open the incision and try to do a fat flap as a revision. This is a good strategy only when there is surrounding fat left. If the patient is thin and the original procedure removed too much fat via lipo or direct excision, it is not always possible.
Solution Two: if there is no fat left, I may still decide to open, and then pinch the underlying areola together from the underside with a suture. This pinching effect can improve the look.
Solution Three: Another solution is subcision and filler. Here we free up the tissues with small blade creating space between the areola and muscle, and insert filler. The filler substance can be fat graft or off the shelf filler. the body will then produce some collagen on its own to replace the filler, but there is a chance that this procedure needs to be repeated more than once.
Solution Three is what I employed here. Results are shown at Six months.
