I have a blood clot after surgery/concerned

[shalala2012]

Tomorrow will be six weeks since my gynecomastia surgery. It included gynecomastia repair with liposuction. My doctor also used drains. Mr right side has swelling and the nipple is very puffy. My doctor says it is a blood clot. He said the surgery was successful and there was not much bleeding during the procedure. He has me coming in once a week and tries to extract the blood a with syringe. He says it is still too firm but it should liquefy very soon. He only recommends that I continue to massage the area. After the third week he said I did not need to wear the compression vest.Also, my surgeon made a 1 to 5 o'clock incision. After all my research from other surgeons and even on his website surgeons always do it beneath the nipple so the scarr is less noticible. He is a board-certified plastic surgeon. Any recommendations and is this normal? Thank you!

[Litlriki]

The risk of bleeding following gynecomastia surgery is low, but it does happen.  It's more common in steroid-related gynecomastia.  In patients who have some bleeding afterwards, if it's significant, it can require immediate drainage and control.  In many patients, however, it's just some minor, slow bleeding, which causes bruising and may lead to what you're experiencing.  In such cases, serial aspiration of the liquifying hematoma can be very effective and avoid re-opening the incisions.  My experience has been that the hematoma can be aspirated starting about two to three weeks after surgery, and more often than not, by six weeks, things are actually looking fairly normal, with the exception of increased swelling on the side where the bleeding has occurred. I'm not sure why your surgeon has not had success in aspirating the clot. 

Positioning of the incision is an individual preference, and I think that most surgeons do place the incision along the lower aspect of the nipple.  The person who ran my plastic surgery program used to sometimes do a trans-areaolar incision--straight across the nipple/areola!  And he is an excellent surgeon who gets great results.  Positioning is less critical, presuming that technique is otherwise meticulous. 

You might post some photos for more informative feedback.

Rick Silverman

[shalala2012]

Today is my seventh week since the procedure. I am posting some photos that I just took a few minutes ago as well as a photo from week 3. I never have been on any steroids. My gnecomastia started when I was 12 years old when I reached puberty. My case was just puffy nipples with the right being bigger than the left. After another visit to the doctor today he told me just to be patient. The clot is coming together and is mostly just under the nipple and not so much all over which the first month I looked like I had a breast. He was not able to get much blood out at all bc he said the clot is "hard as a rock". He said it will just take time. From his tone it does not sound like he has ever had this happen before in his 15 years of practice.

[shalala2012]

Here is a front photo of today (week 7) . The left is perfect.

[shalala2012]

Here is a side photo of week 3.