6 weeks post op - should I massage? Updated with photos

[Deeceebee]

Hi
I had lipo and gland excision performed almost six weeks ago to the day on both sides.


I had my follow up yesterday with my surgeon.  My nipples were completely flat initially after my surgery, now 6 weeks later they have puffed up slightly with really hard mass behind them which he said is scar tissue.
Compression band was worn constantly for six weeks as instructed.


I questioned if I need to massage this and was told no this will reduce over time.  After reading many posts on here should I start to massage the areas to help breakdown the tissue?


If so, is there any good sites or YouTube videos how to do this as I have never been shown?


I can post pictures later if required but very confident it's not residual gland as my surgeon removed almost all and left only a very thin layer to avoid craters.
Any help or advice would be greatly appreciated.

[Dr. Elliot Jacobs]

Your story seemingly fits with the development of scar tissue beneath the areolas.  In my experience, scar tissue takes a bit of time to start -- roughly 3-4 weeks or more and then continues to remain or build between 4 and 12 weeks.  Massage rarely helps -- but it cannot hurt.  

If it still persists after 12-16 weeks, then consider returning to your surgeon to discuss possible cortisone injections to the scar tissue -- it works!

Good luck!

Dr Jacobs

[Deeceebee]

Thanks for your reply Dr. Jacobs, very reassuring.

It seems to only be an issue on the side that had the most gland excision, which I assume is because more work had to be done that side, hence more scarring underneath?

The nipple was completely flat after surgery and for a few weeks whilst I was showering and could have a look.

Seems to have only happened in the last couple of weeks and now that the compression garments is off.  

Will the nipple likely go flat again over time?  How does scar tissue work, will is flatten itself out or does it usually need intervention?

When I pinch the nipples there feels like a really hard nodule kind of thing underneath

[Dr. Schuster]

Massaging after surgery is a surgeon preference. My preference is to have my patients massage beginning three weeks after surgery. I think it helps to reduce and improve lumpiness which inevitable develops. hey begin with light massage and work into deep tissue massage as their tenderness subsides. I also think tht it helps the return of normal sensation to the skin which is typically numb for weeks to months after surgery. 

[DrPensler]

This is a common question after surgery. First there is no downside to massage. More often than not time is the single most important variable in the postoperative course. With any incision there is increased collagen build up with time that maxes out around a month then with time becomes more organized. I don't know what was done at surgery or how long you kept the garment on so with out getting to specific sounds typical and would expect some improvement in the nipple.

[Litlriki]

I'm generally a big fan of massage and I take an approach very similar to Dr. Schuster's.  As for the lump under the areola, Dr. Jacobs has described the common sequence of healing in this area, so it's not unusual for the lump to be very palpable and sometimes visible at the 6 - 8 week post-op visit when patients come in for follow up.  I tell them to monitor the process, and if it's not improving by 3 to 4 months post-op, then I'll consider cortisone to treat the scar. Follow up with your surgeon. 

[Deeceebee]

Thank you all very much for your replies, really appreciated and all taken on board.  

I am now about 11 weeks post op and some of the initial scarring seems to be going down on the more pronounced side.

There still seems to be a very slight 'cone' shape to the nipple on one side when looking side on.  I have attached a picture from the front and side on of the nipple in question.  Could this be left behind gland or still swelling/scar tissue?

I know it's very minor, if it's gland would it even be worth the risk and recovery to get that removed, or as it's only little is there now increased risk of crater by removing too much?

On the whole I'm very satisfied with the result but on that side it's still slightly more prominent that the other side and still does poke through a nicely fitted t shirt.

I've attached my before shot as well so you can compare the and review the result.

On the front on photo it's the left side as you look at it that's the one in question.

Any comments or advice would be greatly appreciated

[Dr. Schuster]

Yes it looks like you have gotten a very good result. If there is still a firm / hard lump beneath the nipple, it could be scar tissue which might respond well to a steroid injection. You should return to your surgeon to discuss. Good luck and congrats.

[Deeceebee]

Yes it looks like you have gotten a very good result. If there is still a firm / hard lump beneath the nipple, it could be scar tissue which might respond well to a steroid injection. You should return to your surgeon to discuss. Good luck and congrats.

Thanks Dr Schuster

Do you think that my nipple will go back a bit flatter in time?  My surgeon said not to massage and that over time any scar tissue would reside?  Does scar tissue always require injections?

After surgery and up to about 5-6 weeks it was flat as a pancake, couldn't go any flatter but seems to have gained some fullness.  Compression was worn 24/7 except showers for 6 solid weeks.  

My only fear is that it's slight gland left behind as this nipple resembles the dreaded cone shape compared to the other side still .

When the nipple is pinched it feels like a hard lump, could that be gland? 

[Dr. Elliot Jacobs]

Your history that the areola was flat for a number of weeks post op would seem to indicate that adequate/appropriate amounts of sub-areolar breast tissue were indeed removed.  Then your story of fairly rapid growth of firm tissue would seem to verify growth of scar tissue -- re-growing gland simply doesn't do that.  One cannot differentiate scar tissue from gland by feel alone -- it is the history that makes the diagnosis.

Should the situation not self-resolve, then suggest returning to your surgeon to discuss a possible cortisone injection in that area.

Good luck!

Dr Jacobs

[Dr. Cruise]

It is a normal part of the healing process for scar tissue to form where the surgery took place. If you don't notice a significant improvement by 16 weeks post-op, return to your plastic surgeon to discuss options such as cortisone injections. In the meantime, you can certainly massage the area if you would like as there is no downside in doing so.

Best,

Dr. Cruise
Newport Beach / Los Angeles 
949.644.4808
inquiry@cruiseplasticsurgery.com

www.lagynecomastia.org