Chest wall depression or crater deformity after gynecomastia treatment Austin Gynecomastia Center

Like any surgical procedure, there are associated complications and undesirable consequences that can occur with the treatment of gynecomastia. This educational content will focus on a chest depression or crater deformity resulting from gynecomastia surgery.

For the record, I am the surgeon of the famed Austin Gynecomastia Center where I have performed well over 5,000 cases, many of them advanced, and I am often asked to treat cases that have had multiple previous surgical procedures. Let me share with you what I have learned about depressions, contour irregularities, and crater deformity after gynecomastia surgery. Gynecomastia surgery is all about removing tissue and performing liposuction as needed.

Gynecomastia tissue is almost always well-localized (you can easily feel where it is from beginning to end). It is always centered at each nipple-areola complex and radiates outward on the chest. I almost always remove the tissue as an entire, intact mass (watch my videos). The purpose of liposuction is that it allows the surgeon to contour the entire chest so the final result after mass removal is smooth and flat.

Liposuction became a common gynecomastia tool in the late 1970s, and it improved gynecomastia results immeasurably since. In fact, in papers published before the use of liposuction in the treatment of gynecomastia, many authors suggested the treatment of gynecomastia was worse than the condition! Before liposuction was available, any gynecomastia tissue removal alone caused an obvious crater deformity. If you remove a mass, you have a hole, and if you don’t fill in the hole or contour the surrounding area, you have a crater.

You can imagine that liposuction allowed the surgeon to remove the gynecomastia mass and then use liposuction to contour the surrounding area so the final result is more even. Historically, many surgeons were taught to actually leave some gynecomastia tissue under the areolas to avoid a depression or crater. Unfortunately, this resulted in leaving the critical gynecomastia tissue under the areolas that causes puffy nipples. This residual tissue was also the source of patient dissatisfaction, as they continued to have puffy nipples, and their chest wasn’t as flat as they would prefer. Indeed, the most common cause of gynecomastia recurrence was not actual regrowth of new tissue but leaving behind hormonally active tissue that the patient can see and feel and that can regrow.

My paper published in 2020 introduced the world to the complete removal of gynecomastia tissue. What was proven with many thousands of cases is that you can have your cake and eat it too—I am able to remove all the tissue and contour the chest up nicely for optimal patient satisfaction and the least likelihood of recurrence.

Having said all the above, it’s possible to still have some results with depression or contour irregularity. How does this happen? The explanation can get lengthy and involved, but the simple answer is that by removing all of the gynecomastia tissue, it may be possible to develop a slight depression. This is because many of the masses are dense, stuck glandular tissue that, after removal, it’s difficult to achieve absolute perfection, even with the most advanced contouring and layered deeper closure, as I published in my paper.

An issue not explored in the treatment of gynecomastia and the appearance of depression is the actual changes in the thorax caused by the mass effect of the gynecomastia tissue. This firm, dense tissue over time places pressure on the anterior ribs that can cause a depression. It’s more likely to occur in those gynecomastia patients with firm, stuck masses who have very little body fat. My ability to rotate in some normal deeper tissue to fill the depression is a critical component of my gynecomastia technique.

How do I avoid any possible evidence of depression or divot after gynecomastia treatment? The answer to this question is simply to forgo surgery or leave enough tissue behind so there is no possibility of a crater. The problem is that living with gynecomastia is not fun, and leaving gynecomastia tissue behind is not desirable if the goal is a masculine, sculpted chest without gynecomastia tissue or puffy nipples.

The treatment of gynecomastia is an art form. Leave too much, and the patient will complain that their chest looks no different than before surgery. The ultimate objective is to remove all the gross gynecomastia tissue and then contour the remaining normal tissue so the final appearance is sculpted and natural-looking. Ninety-five percent of patients are very pleased with their gynecomastia treatment at the AGC. A small percentage have issues that include depressions and other contour irregularities that can be considered quite “minor” by most.

No surgery is perfect, but it’s nice to know that most patients’ results are perfectly amazing.