Kenalog after surgery

[Swampsong]

I recently had my 3 month follow up with a reputable gyno surgeon in Toronto and I expressed my concerns. My right nipple seems to have a much heavier scar density under the nipple but my surgeon said that it didn't require any steroid injections and that it should heal normally with in a year.

My question for other surgeons is how often do you administer steroid injections to patients?

What timing and what feeling/look leads you to prescribe these injections? Also how long does it typically take for the nipples to completely flatten?

[Dr. Elliot Jacobs]

These are just general comments and may not pertain to your specific case.

Many patients are concerned about scar tissue developing after gyne surgery.  Actually, the body normally heals with scar tissue -- it is a good thing.  There is always a normal amount of scar thickening along the length of the peri-areolar scar.  This is normal and tends to subside in time, although on rare occasions, I will inject a little cortisone to reduce some persistent thickening.

What is of concern is the excess development of scar tissue, which unfortunately seems to occur (for unknown reasons) directly under the areola.  This must be differentiated from possible retained breast tissue.

The development of scar tissue usually starts within several weeks after surgery and continues for several months.  It then tapers down and softens over the ensuing months -- but may not totally disappear.  Hence, if you were absolutely flat and contoured after surgery, then one may surmise that most/all of the gland under the areola has been removed.  You should confirm this with your surgeon -- he/she was there and knows exactly what was done.

If you are now developing some thickening and scar tissue under the areola, then it is most likely scar tissue.  If it starts early (ie, within 2-3 months) and is soft but bulky, then I may intervene with a mild dose of cortisone.  If it is very firm, bulky or appears later, then I usually go with a stronger dose of cortisone.  Usually I like to get all the cortisone treatments done and secure good results by about 6-7 months post op.  On occasion, there is continued improvement and softening up to about one year.

Bear in mind, if cortisone is injected properly into scar tissue, there is no scar tissue that will be resistant to it.  On the other hand, if one attempts to inject cortisone into residual gland tissue, it will have negligible effect,

Many patients become unduly concerned about scar tissue, even in small amounts.  They believe that if they feel something, then it has to be treated. No true!  Be aware that gyne surgery is performed so that one has good chest contours -- it is not performed so that afterwards your chest will pass the "feel my chest and tell me if you feel something" test. On the other hand, if there are definite contour problems after surgery, particularly in the nipple area, then re-evaluation by your surgeon is suggested.

Treatment with cortisone is tricky and it should be administered by a physician who is cognizant of its side effects and expert in injection techniques.  Above all else, you should follow your own surgeon's advice.  You trusted him to do your surgery -- why not trust him for your follow up care?

Hope this helps

Dr Jacobs

[Litlriki]

Dr. Jacobs has provided an excellent explanation.  Very comprehensive.