2 years post op Muscle tear. Can it Be fixed??

[Oz777]

Hi,
I have a muscle tear behind my nipple from a botched surgery.
I also get pain in the area, which comes and goes, but its been almost 2 years and it doesn't seem like the pain will go away.
The Tear is vertical, right behind the nipple and the outer part of the muscle tear seems to be detached from the rib cage and is coiled up like a blob, sitting higher than the inner part of the pec muscle.

My question, Is it possible to repair a 2 year old muscle tear? If the muscle tear can't be fixed can the muscle at least be reattached to the rib cage so it sits in its original position?

I have been to a few orthopaedic surgeons, but they turned me away as they didn't seem to want to deal with such a rare injury. I'm finding it really hard to find anyone in Australia that specialises in these kinds of soft tissue tears.

I am willing to travel overseas if there is a chance of repairing this injury.
I recently got an MRI scan if anyone would like to view them just pm me.
Any advice/opinions  would be greatly appreciated..

[Dr. Elliot Jacobs]

It would be extra-ordinarily unlikely for any decent surgeon to dis-insert part of the pectoralis major muscle during a routine gynecomastia operation -- but I guess in this world anything can happen.

If indeed this is what happened, then unfortunately there would be no way to re-attach the muscle from where it originally attached on the ribs.  In thinking about your situation, I do not believe it is fixable.  Truly sorry.

Dr Jacobs

[Oz777]

It would be extra-ordinarily unlikely for any decent surgeon to dis-insert part of the pectoralis major muscle during a routine gynecomastia operation -- but I guess in this world anything can happen.

If indeed this is what happened, then unfortunately there would be no way to re-attach the muscle from where it originally attached on the ribs.  In thinking about your situation, I do not believe it is fixable.  Truly sorry.

Dr Jacobs

Thank you for replying.
So it can't be re-attached to the ribs, but can anything be done about the vertical tear at this 2 year stage? I ask this because it's causing pain and atrophy of the inner side of the pec muscle. Is there no way to release scar tissue and promote healing with some kind of suture?

[Dr. Elliot Jacobs]

Sorry -- can't answer in your particular case.  Surgery to remove pain is very problematic.  Once the muscle has retracted upon itself, it is virtually impossible to extend it.  Further, suturing muscle is very difficult because sutures literally tear through the muscle fibers.

Dr Jacobs

[Oz777]

Sorry -- can't answer in your particular case.  Surgery to remove pain is very problematic.  Once the muscle has retracted upon itself, it is virtually impossible to extend it.  Further, suturing muscle is very difficult because sutures literally tear through the muscle fibers.

Dr Jacobs

Thanks for your input.
Would a fat flap procedure be recommended to fill in the obvious tear area? 

[Litlriki]

I would agree with Dr. Jacobs assessment so far. It is strange to have this sort of thing happen during gynecomastia surgery, and I'm not sure exactly what it would look like, so if you can post some photos, we might be able to offer some advise to camouflage the problem.  Surgery for pain as you've described can be challenging, unless there's clearly some sort of restricting scar that can account for the discomfort.  Release of the scar can then help with the pain. 
Please post some pics. 

[Dr. Elliot Jacobs]

It would be very helpful if you would post some photos in various positions (ie arm at the side, arm raised, front and 3/4 views, etc).

Based solely on your description, I doubt whether fat flaps would be useful.  However, this might be one instance where serial fat grafting might be of help.  Of course, this all depends on the photos.

Dr Jacobs

[Dr. Schuster]

I read your questions and answers with some interest. How have you been able to determine that there was in fact a tear in your muscle, and be so exact that it was "vertical". I don't believe that this would show on an exam unless you were extremely lean. Likewise I am not sure that there would be any reliable test (MRI, Ultrasound) which could be dependable. Before you get any surgery you need to be able to make an accurate diagnosis. Be careful.