Keloids & Puffy Nipples

[dondada7]

Hello Doctors,
I had gynecomastia surgery in early june and and I am mostly satisfied but there are a few things that have me worried. I have keloids where the incinsions were made (this was something that I knew would most likely happen because my skin is highly susceptible to keloids) im using mederma but I was wondering if there is anything else I should do. Also one of my nipples is still puffy while the other ones flat. Do you have any suggestions or advice???

[Dr. Elliot Jacobs]

Would recommend you return to your surgeon.  True keloid scars are most unusual -- a keloid scar by definition is a scar which is widened and raised and actually grows beyond the confines of the original scar.

What you have is probably a hypertrophic scar -- that is, slightly thickened and perhaps raised slightly above the surface of the surrounding tissues.  This can usually be treated with a kenalog (a steroid) injection.

As for residual puffiness, a discussion with your surgeon is suggested.  If he is sure that he removed all the excess tissue, then perhaps you also have scar tissue beneath the areola (yes, it can happen on one side only).  If so, then again a kenalog injection may be of help.  On the other hand, if the surgeon feels he left some tissue, then perhaps a revision may be required.

Dr Jacobs

[DrBermant]

Hello Doctors,
I had gynecomastia surgery in early june and and I am mostly satisfied but there are a few things that have me worried. I have keloids where the incinsions were made (this was something that I knew would most likely happen because my skin is highly susceptible to keloids) im using mederma but I was wondering if there is anything else I should do. Also one of my nipples is still puffy while the other ones flat. Do you have any suggestions or advice???

True keloids are scars that grow beyond the wound's original borders and can keep growing. They tend to itch. Each generation of Plastic Surgeons tends to think they have finally discovered the "magical" treatment for this problem. There are tons of papers with such claims. The problem is that they just do not work, if they did, there would not be a continual stream of new papers still claiming to have the new "cure."

I have seen keloid forming patients who had massive scars just from a tiny mosquito bite.  For some the pattern for these tiny scars evolve into butterfly like shapes.  Others can have large egg shaped scars from the tiny hole from an ear piercing.  Someone who has a high tendency to true keloids should carefully consider elective surgery, wearing earrings, getting tattoos, and other such activities. Subtle gynecomastia that turns into a thick deforming scar larger than the original problem is just not a appropriate trade off in my opinion. The scars can extend beyond the surface to deeper tissues.

Avoiding the original optional surgery would have been a better choice.  Treatment options at this point depend on the actual problem, what was done, surgical technique, after surgery care, and many other factors best discussed with your surgeon.  Even scar revision and revision surgery carry risks in the bad scarring patient.  Scars cannot be removed, they are replaced by new scars.

Hope this helps,

Michael Bermant, MD
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