Secondary Surgery: Do It Again the Right Way

            A good part of my practice is correcting surgery patients have already had. Whether it's liposuction, gynecomastia correction or implants, the patient finds that the results of the original surgery are not what he or she wanted or expected. Correction requires a careful analysis of the problem and a plan on how to correct it. The original surgery has left scar tissue behind and altered the normal anatomy of the areas in question.

            The typical problems seen with liposuction are unevenness, too little removed, or too much. The problem of too little removed by an inexperienced or a too-conservative surgeon is the easiest to remedy.  However, a careful plan has to be devised. Liposuction should be thought of as a sculpting, not just  removal of tissue. What is left behind is as important as what is taken away. A poor plan can merely replace one bad result with another. It's vital to know what the ideal thickness should be and to carefully achieve it. I find the use of power-assisted liposuction equipment is essential in these cases. Traditional liposuction instruments have difficulty evenly removing previously scarred areas. Ultrasonic equipment tends to lack the precision needed. The experience of the surgeon coupled with the right instruments can give the desired outcome.

            Unevenness is caused by isolated areas from which the proper amount of tissue has not been removed. This is often seen in the love handle regions or lateral chest. The fat in these areas has a fibrous component and is more difficult to remove. At times, there has been too much fat removed with resulting indentation and dimpling. The solution can require suctioning from one area and re-injecting it into the deficient region.

            The most common post-operative problem with gynecomastia is the belief of some doctors that liposuction alone can treat all cases of this problem. Usually liposuction will remove the fatty component, but not the glandular one. The patient will look better during the early swollen stage, but with time, winds up with a firm nodule or drooping of the nipple. This is corrected by careful open surgery to remove the proper amount of glandular tissue.

            Another problem is removal of too much glandular tissue with scarring down, anchoring and indentation of the nipple complex. Fear of this is what causes many doctors to hope that liposuction alone will correct the gynecomastia. The correction requires the use of grafts of either tissue from another area of the body or artificial material to fill the area and eliminate the depression. This should not be confused with a situation in which the proper amount of tissue is removed from beneath the nipple, but the surgeon has ignored the lateral extension of the gynecomastia under the arm. This correction requires the removal of this additional tissue with occasional transfer of some of it under the nipple.

            Implant problems arise when the surgeon may not be aware of the ideal contour he is trying to simulate. The doctor should be able to determine the right size, shape and position of the implants. I have had to replace or modify implants that feminized the chest rather than giving the ideal male look. Calf implants should blend with the thigh sweep and give a proper transition from knee to ankle.

            I have found that it has taken my combined experience as a surgeon, bodybuilder and sculptor to solve the problems that unsuccessful initial surgery has created.