Oftentimes, men have had gynecomastia surgery utilizing some form of liposuction only. This can leave irregular areas of residual tissue (felt as thickened areas) as well as areas of over-removal (felt as very thin areas). Sometimes so much tissue has been removed that the skin is “stuck” to the underlying muscle, which can create laxity, dimpling or cratering upon movement of the arms. Revision surgery is often directed to removing the residual excess tissues in order to achieve a smoother contour with a uniform pinch of skin and fat. This is usually accomplished with very precise additional liposuction. Laser liposuction touted to be the “latest and greatest” actually results in severe scar tissue formation and it has yet to be proven to aid in skin tightening. Further, it has no effect on gland tissue.
When too much tissue has been removed, then it must be replaced. This can be done with the use of fat grafting or fat flaps. When dimpling occurs, the skin must be detached from the underlying muscle and then some type of fat tissue placed in-between (as a “spacer”) so that the skin does not re-attach at the same place. This entire process of dealing with areas of irregularity may be thought of as hills and valleys. Revision surgery is basically aimed at reducing the hills and filling in the valleys in an attempt to obtain a smooth and level plane.