Gynecomastia

[maroda]

I had gynecomastia surgery 5 months back. On my last visit to my doctor 4 months post surgery i complained from feeling a hard lump behind and around the areola, but the doctor insisted that it is only scar tissues and will be resolved over time but i still have doubts and need your advise.
Attached 1 photo before and 3 after the surgery.


thanks in advance

[Dr. Schuster]

Hard lumps after surgery is common. They are usually the result of scar tissue and will generally improe on their own over three months. If they are still there after three months I will often perform a Kenalog steroid injection. As long as you can't see the effect of the lump don't sweat it.

[Litlriki]

I advise my patients that I'm not worried if they can feel a lump after surgery--only if they can see it.  This is especially true of the remnant left behind under the nipple, which can be very hard in some patients who have a history of medication or steroid use. If there is a lump that I believe is scar tissue and it's present beyond 3 - 4 months with a visible component, then I'll use Kenalog to address it.  

[maroda]

Thanks doctors for your reply.
I am concerned just becuase i am 5 months Post op and still having puffy nipples and not sure if the gland was totally removed by the doctor.

[Litlriki]

I'd probably try Kenalog before anything else. 

[maroda]

Thanks doctor for your reply.
I met my surgeon and he informed me that no need for kenalog as the internal scars will disappear by itself?
Do scars fade over a period of time?

[Litlriki]

Scars do fade, shrink and soften over time.  At 5 months, if there's still a lump under the nipple and it causes visible prominence that's disturbing my patient, I will typically try the Kenalog, but all surgeons have their own approach to managing this. 

[Dr. Elliot Jacobs]

Totally agree with my colleagues.

One point to be considered.  The presence of a non-visible but feelable lump under a nipple is a frequent consequence of surgery.  In this circumstance, there is no need to do anything -- scar tissue is the natural way in which the body heals.

I have a small number of patients who look absolutely great after surgery -- but they feel "something" under the areolas (ie scar tissue) and they obsess over it.  The problem is that neither the patient nor the surgeon controls how the body heals.  I urge these patients not to fall into the "feel my nipple and tell me if there is something there" test.  Bottom line is that most likely there is some scar tissue there -- but it is innocuous.  And sometimes, if one tries to treat this lump delicately with kenalog, one can get atrophy and a depression of the nipple, which cannot be corrected.

Don't snatch defeat from the jaws of victory!  Accept a 98% improvement instead of tryng for 100% -- and perhaps having a poor result from kenalog.

On the other hand, if there is a visible lump many months after surgery, then kenalog should be considered.

Dr Jacobs

[Litlriki]

Dr. Jacob's comments are very important! Our treatment is aimed at making your chest LOOK better. The only reason to treat lumps and bumps is if they cause a visible defect. 

[maroda]

Thanks doctors.
Without kenalog steroid, when it is expected to see the final results? noting that i am almost 7 months post surgery and still with puffy nipples and hard lumps.

[Dr. Elliot Jacobs]

Healing may take up to a year -- but often what you see at 6 months is pretty much what you will end up with.

Would recommend you return to your surgeon to discuss what, if any, treatment might be indicated.

Dr Jacobs

[Dr. Schuster]

I agree with everything that has been said since my earlier reply. At 7 months after surgery you probably are seeing the final result. If you don't like what you see you need to discuss with your surgeon. If you look good but can feel a little thickening I would suggest leaving it alone.

[maroda]

I am attaching a new photos. Could u plz advise if i need a revision surgery.

Thanks a lot for ur replies

[Dr. Elliot Jacobs]

If liposuction (only) was done, then more than likely you have residual tissue under the nipples.  I think there is more on the right than the left.  If the surgeon did excise breast/gland, then you should speak with him and ask how much, if any, was deliberately left behind.  Realize, it is impossible to tell if you have gland or scar tissue based on photos alone.
If it appears that no gland or minimal gland was removed, then yes, a revision would be indicated.  Be sure to get another opinion from an experience gyne surgeon.

Dr Jacobs

[DrPensler]

A pure lateral view as opposed to a 45 degree view would be helpful. Its normal to have some firmness but if at 6 months there is excessive prominence a revision would be in order .The issue is the appearance not the feel.