Possible Hematoma and Extra Scar Tissue

[shalala2012]

It has been 9 weeks since my surgery.It involved liposuction, gynecomastia repair and drains were used.   The case was originally just puffy nipples that I had when reaching puberty about 12 years ago. My left side was immediately flat 3 days after the surgery, it now looks PERFECT. My right side was swollen like a balloon. I have been going in once a week to get blood drained by a syringe by the doctor. However, he has not been able to ever get much out because it is very thick. He said it is a blood clot and this is "an annoying set back".  He said in the beginning that it should liquefy and it would go down very fast. Over the first five weeks the swelling went down in my chest but my nipple is extremely puffy and hard as a rock. He said usually in patients that it liquefies but has not in my case. It has been this way for about 3 weeks and has not changed. He now says there may be extra scar tissue and some hematoma. He said he may need to operate again on that side, but he wants it to heal more.Is this normal? I am posting photos from today to give you an idea of what it looks like.

[Dr. Elliot Jacobs]

No, this is not normal.  Both sides should ideally be the same.

At 9 weeks, any blood is now solid and changed to scar tissue -- so further attempts with a needle will likely be futile.

You will most likely require revision surgery -- but I agree with your doc that waiting for about six months would be best.  It will allow for your body to remove some (perhaps a lot) of the scar tissue by itself.  The tissues will also be softer and easier to operate upon.

Waiting this time will undoubtedly test your patience but really, at this point, it is the best way to go.

Good luck.

Dr Jacobs

[DrBermant]

It has been 9 weeks since my surgery.It involved liposuction, gynecomastia repair and drains were used.   The case was originally just puffy nipples that I had when reaching puberty about 12 years ago. My left side was immediately flat 3 days after the surgery, it now looks PERFECT. My right side was swollen like a balloon. I have been going in once a week to get blood drained by a syringe by the doctor. However, he has not been able to ever get much out because it is very thick. He said it is a blood clot and this is "an annoying set back".  He said in the beginning that it should liquefy and it would go down very fast. Over the first five weeks the swelling went down in my chest but my nipple is extremely puffy and hard as a rock. He said usually in patients that it liquefies but has not in my case. It has been this way for about 3 weeks and has not changed. He now says there may be extra scar tissue and some hematoma. He said he may need to operate again on that side, but he wants it to heal more.Is this normal? I am posting photos from today to give you an idea of what it looks like.

It is not normal to have such residual contour problems after surgery. In my practice I see a hematoma perhaps once every 2 to 3 years, and that is without drains and usually after a patient has done something unusual. Although that side resolves slower than the other, drainage should bring them close to each other on contour. Just the residual firmness is the major concern my patients are working on.

Residual deformity can be from the remaining hematoma organizing itself into scar, scar from the surgery, and or remaining gland not removed. It is normal for the resolution of swelling to take much longer when a Hematoma Complication of Gynecomastia Surgery has occurred. But by 9 weeks, the difference should be much less. Waiting until tissues heal and soften before considering revision surgery can take 6 months or more.

Hope this helps,

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

[Dr. Cruise]

Blood collections after surgery happen.  This is a possible complication from any surgery.  typically i put There is a critical period where hematomas can be drained.  This is typically within the first 3 weeks after surgery.  After 3 weeks, the body actively "organizes" the hematoma into scar tissue making removal of the scar tissue extremely difficult. For this reason, you should wait until your body completely heals and begins to happen.  The scar tissue will begin to soften at about 6 months.  For this reason, it is best to wait at least 6 months before considering your revision. 

Routinely, I see my patients the very next day after surgery.  If I suspect hematoma, I will open the wound and drain it immediately.