how to identify swelling vs scar tissue buildup

[pinchy68]

I am now 18 days after surgery. I had a minor case - excision-only with some small amount of tissue removed directly under the areola , mainly just shaping the nipple, with local anesthetic only. On the left side the doctor also removed a tiny bit of fat below the nipple to shape the area (I am fit, there was not much fat to start with). The shape of the chest right after the operation looked very good. Now, 18 days after surgery I have something there that wasn't there before the surgery. There was very little fat there before the surgery, but now there is clearly identifiable tissue, thumb size but not very thick, that I can feel and see. It is not hard, it doesn't seem to have clearly defined hard edges. It is not going down. If anything I would say that it has slightly increased over the last week.
Here is the question:
Is it a scar tissue buildup (would scaring be building up in the injured fat underneath the skin?) or is it swelling?
If it is swelling - can it feel like real tissue. It is not hard, but firm.
If it is scar tissue building up, should I be massaging it?
Can this be a result of not wearing compression vest for days 3-8 after surgery (I was told I don't need it, I have been wearing it since)? Right now the results of the operation appear to be on the left side as if tissue was added not removed, even though I clearly saw that some amount of tissue was removed.
I would greatly appreciate your answers.

[DrCALOCA]

If you saw acceptable results right after surgery, then this is what to expect as far as final reslts are concerned. Volume after surger can be caused by blood (hematoma), serum (seroma) and usually NOT scar tissue. Swelling is obviusly another factor that can cause volume. Sometimes a little bleeding occurs, this blood dries inside and forms a little "clot" that can take up to three months to absorb.

In summary if right after surgery you saw great results (as you mention in your post), then you should be OK once swelling goes down.

[DrBermant]

I am now 18 days after surgery. I had a minor case - excision-only with some small amount of tissue removed directly under the areola , mainly just shaping the nipple, with local anesthetic only. On the left side the doctor also removed a tiny bit of fat below the nipple to shape the area (I am fit, there was not much fat to start with). The shape of the chest right after the operation looked very good. Now, 18 days after surgery I have something there that wasn't there before the surgery. There was very little fat there before the surgery, but now there is clearly identifiable tissue, thumb size but not very thick, that I can feel and see. It is not hard, it doesn't seem to have clearly defined hard edges. It is not going down. If anything I would say that it has slightly increased over the last week.
Here is the question:
Is it a scar tissue buildup (would scaring be building up in the injured fat underneath the skin?) or is it swelling?
If it is swelling - can it feel like real tissue. It is not hard, but firm.
If it is scar tissue building up, should I be massaging it?
Can this be a result of not wearing compression vest for days 3-8 after surgery (I was told I don't need it, I have been wearing it since)? Right now the results of the operation appear to be on the left side as if tissue was added not removed, even though I clearly saw that some amount of tissue was removed.
I would greatly appreciate your answers.

18 days can be very early after surgery with some techniques.

Posting Standard After Gynecomastia Pictures can help other better understand your concerns.

How Soon Do You See Results After Gynecomastia Surgery depends on many factors, we tend to see instant results for my patients.  However, I prefer to optimize Healing After My Male Chest Surgery such that early results are possible.

Firm tissues after surgery can be residual gland, but also can just be healing tissues or scars.  Different surgical techniques injure tissues to different degrees. Time to tissues softening can vary depending on the original problem, what was done, after surgery care,
Scar Care, After Surgery Compression Garments, and many other factors.
 
Even if the doctor achieves a flatter chest, that firm mass does not look like fat, move like fat, or compress like fat.  It just does not move well or look good (especially on animation).  That is why few doctors will show results with chest muscles tightened or arms up over the head or movies showing the tissues in motion.

I feel the garments are critical to achieve my typical Swelling, Bruising and Comfort After Gynecomastia Surgery.  That is why every one of my patients is fitted with both Stage I Compression and Stage Two Compression garments before surgery.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia Surgery

[Dr. Elliot Jacobs]

Still much too early in the healing game.  Recommend continued use of a snug compression garment and check with your surgeon.  Remember, healing will take many months.

Dr Jacobs

[DrBermant]

Thank you for your reply.
I am still confused about this. It appears that the mass is definitely increasing in size. How can I have something there that wasn't there before? It wasn't there even few days after the operation either. I am afraid that it is a scar tissue buildup that just keeps growing. I don't think it's a gland since I had no gland there to start with.
Should I massage it? I am 19 days post op.
Thank you.

Rapid change of size is not typical for scar tissue. Such issues should immediately be brought up to your surgeon who is familiar with the original problem and what was done.  Fluid build up such as a Hematoma After Gynecomastia Surgery is one such complication that is extremely rare for my practice, but can happen.

As swelling goes down, remaining gland and other contour irregularities can be revealed.  Scars generally evolve over time.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

[Dr. Elliot Jacobs]

Don't try to be a doctor and diagnose/treat yourself.  If you trusted your surgeon to operate on you, then trust him/her to carry you through the entire procedure and healing phase.

You are truly at the beginning of a lengthy healing period. There will be many changes in your chest before the final results are seen.  What you are seeing/feeling is probably swollen tissue -- perhaps with early scar tissue.  It is too early to do anything!!  Best thing is to sit on your hands, do nothing and allow your body to heal.

Steroids are wonderful -- but only when used by your surgeon at the appropriate time and location.  Again, at this stage, steroids should not be used because you don't know what you are treating -- scar or swelling (ie water).  And topical steroids will do nothing.

Best advice:  chill and get your mind off your chest and onto something else. 

Dr Jacobs