Is crater deformity a result of bad gynecomastia?

If yes, what can I do to solve this issue? Should I address it to the same doctor? It's been over an year since I had the gynecomastia surgery, he may not even remember me. Can it be solved in a non-invasive way, with fillers or some other liquids/fat? I suffered enough from the previous surgery, and I'm not exactly thrilled to start over. Any help is much appreciated.


M, 39, New York

Tags:man age 35-44 chest gynecomastia non surgical

Crater deformities are NOT the normal result of gynecomastia surgery -- it represents over-zealous removal of gland tissue under the areolas without compensatory removal of surrounding tissues, which are usually mixes of gland and fat.  

You should, of course, visit your surgeon to discuss the issue.  You should also visit at least one or more gyne experts in your area.  

Revision surgery is always more difficult to perform.  I usually prefer fat flaps to fat grafting for a more predictable outcome.

For further info on gyne revision surgery, please visit my website, which is solely devoted to gynecomastia:

Good luck!

Elliot W. Jacobs, MD, FACS

New York City

Elliot Jacobs has 3 Gynecomastia reduction before & afters:

Gynecomastia reduction before image performed by Dr. Elliot Jacobs Gynecomastia reduction after image performed by Dr. Elliot Jacobs Gynecomastia reduction before image performed by Dr. Elliot Jacobs Gynecomastia reduction after image performed by Dr. Elliot Jacobs Gynecomastia reduction before image performed by Dr. Elliot Jacobs Gynecomastia reduction after image performed by Dr. Elliot Jacobs

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Plastic surgery always carries a certain level of risk. Gynecomastia surgery is a specialized surgery that, to eliminate the likelihood of complications occurring, should only be performed by a surgeon with expertise in the procedure. Unfortunately, in the hands of a less experienced surgeon, unacceptable results can arise.

One common complication that can occur is crater deformity, which results from excess tissue being removed from around the areola and nipple area. Instead of a smooth, firm chest contour, there is a depression and the nipple appears sunken, like a crater, and, in rare cases, the nipple may fold in on itself.

The severity of crater deformity can vary, but in most cases the contour irregularity is noticeable and will not resolve on its own. Frequently, this deformity is caused by poor surgical technique. It is critical that you seek the assistance of a gynecomastia surgeon with experience carrying out revision procedures to help you resolve this complication.

Two issues must be addressed in order to correct a crater deformity: the release of scar tissue and the grafting of living tissue to fill in the depression beneath the areola. Unfortunately, fillers are not a suitable option as they only offer a temporary solution. Many surgeons who perform gynecomastia revision surgery use structural fat grafting to address these two issues.

Fat grafting involves the harvesting of fat from another part of the body, such as the flanks, by aspiration. The aspirated fat is cleaned, processed and transferred using blunt cannulas to restore contour to the depressed area. Cannulas with a V-shaped edge are used to release scar tissue. These cannulas are shaped to pass through tethered scar bands, so the tissue in the indented area can be expanded. Often, more than one procedure will be necessary to gain the best possible outcome.

For an enduring correction of chest contour deformities, seek the advice of a surgeon who has experience dealing with this challenging issue so you can be assured of an aesthetically pleasing outcome.

Crater deformities arise when the glandular tissue in the central area of the male breast is removed without adequate contouring of the surrounding breast tissue. During male breast reduction surgery, what is most important is not how much tissue is removed but, rather, the way in which the remaining tissue is redistributed in the chest area. A smooth appearance is critical.

As a patient, you have the right to expect an impeccable standard of care from your plastic surgeon. However, from time to time, issues arise. In these instances, definitely contact the surgeon who performed your gynecomastia surgery, no matter how much time has lapsed. Your surgeon will be able to explain why the crater deformity has occurred and subsequently inform you of what your options are so you can decide together on how to proceed.

While it makes sense to voice your concerns to the surgeon who performed the surgery, in certain cases it may be preferable that a board-certified plastic surgeon with expertise in repairing contour irregularities carry out the revision. Gynecomastia revision surgery can be complicated because of the presence of scar tissue. The healing process can also be somewhat unpredictable.

The good news is that crater deformity can be successfully treated. Your surgeon will be able to advise you on the procedure or procedures that will provide you with an optimal outcome. In severe cases, however, a two or three-step approach may be needed. Three of the most common surgical treatments for crater deformity are:

1. Fat grafting

Fat grafting (also known as fat transfer) is a surgical procedure where  the patient's own subcutaneous fat tissue is used to add volume elsewhere in the body. The technique involves removing tissue from an area of the body that has an abundance of fat and transferring it to the appropriate area.

2. Liposuction

Liposuction can effectively treat contour deformities by redistributing the remaining fat in the breast. Liposuction tools such as the MicroAire Power-assisted Liposuction (PAL) device can perform this effectively, with the aspirator setting turned to off so that fat is only redistributed, not suctioned out.

Flared cannulas are used which can effectively release subcutaneous scar tissue and smooth out the fat layer. Any remaining deposits of fatty tissue can be reduced with low-volume liposuction by using very small, non-flared cannulas.

3. Fat flap

Fat flap is another effective method of correcting crater deformity. During this procedure, fat tissue that is still attached to its blood supply is rotated into the crater deformity.

Crater deformity can occur when more tissue is taken from right under the areola than the thickness of what is removed from surrounding. The tradeoff is that in an effort to get a smooth result, sometimes the surgery can result in mild contour depressions in other areas. Often these will settle on their own but if there is a deficiency in tissue, fat grafting is often the desired approach. You could try Sculptra to see if it would create some collagen remodeling and as a "dry run" for fat grafting, but the product is not cheap. Pec implants with or without fat can actually further enhance the manly chest appearance in patients who maintain reasonable fitness through diet and exercise.

Consider some second opinions in addition to giving your plastic surgeon a chance to manage this with you.

-- Dr. Sayed

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Hi. Fat grafting is a possibility if the previous liposuction and excision was aggressive. In some cases, as silly as it sounds, firm pectoral implants (not to be mistaken with breast implants) can also lead to an awesome masculine result - especially when combined with fat grafting. But fat grafting is a good starting point. Maybe find another plastic surgeon?