Nipples Puffy 3 and a half months post-op

[John495]

I had the surgery about 3 and a half months ago. Small incision on the bottom of each nipple, no lipo was done. Post surgery went very well. There was minimal swelling, no bruising, and very little pain. I wore a compression vest day and night for the recommended 4 week duration. Immediately after 4 weeks, I was told I could resume weight lifting, so I did. For the first 3-4 weeks post op, my chest was perfectly flat, and the results seemed incredible. After about 4 weeks when I stopped wearing the vest, my nipples gradually became more and more puffy, similar to before surgery. I noticed that there were some firm lumps under the nipple, which I suspected to  be scar tissue. I went back to my surgeon with my concerns (around 2 months post-op). He said that there was almost no glandular tissue left, and that I had some scar tissue, but not a lot. He said that where I was at then (2 months post) would be what my final result looks like. Ever since then, I have been massaging the area every night. I can feel a reduction in the scar tissue, but there is still some there. I also still have a considerable amount of pain in the nipple area when I massage it and touch it. My big question now is I am wondering if I still have too much gland tissue behind the nipple? I feel stuff behind the nipple that is similar to what I felt before surgery, the only difference is now, when I feel it, It hurts badly. It is slightly firm, but also feels very broken up. Almost like little grains of rice. I have read a lot about post surgery puffiness being due to scar tissue, especially when the chest is flat for a few weeks after surgery. I am just wondering if what I have now could be scar tissue, or just left over gland tissue. Any responses will be greatly appreciated.  

[Dr. Elliot Jacobs]

Scar tissue generally requires a few weeks to even start to develop after surgery.  If your nipples were flat for one month and then began to puff out, then perhaps there is indeed some scar tissue causing the problem.  However, understand that lipo is a very important part of virtually every gyne operation because it removes surrounding tissue and also allows the skin to contract.
Perhaps the best course of action is to wait it out for another month or two and see if there is any improvement.  If not, then consider some cortisone injections.  Bear in mind, if there was inadequate removal of gland tissue beneath the areola, then future cortisone injections will not work -- it would require revision surgery.

Dr Jacobs

[Litlriki]

I have many patients who present with fairly mild puffy nipples and in those cases, sometimes scar tissue can be more significant than the original gynecomastia and in such cases, a cortisone (Kenalog) injection is often effective to reduce the scar tissue.  As Dr. Jacobs pointed out--if it's gland and not scar, it won't get better and more tissue would need to be removed.  The other thing you mentioned, as you stopped wearing the vest--the tissue swells a little after the vest is discontinued, so it's common to be more aware of the puffiness at that point. Often it resolves on its own without injections as the swelling resolves.