Post-Surgery Gland vs Scar Tissue

[David1991]

I had gyno surgery (lipo + ultrasonic lipo + gland excision) on 12/27/13. I had my 2nd follow up yesterday and told him I am concerned about how puffy they still are, as if a good deal of fat was taken out but not all of the gland (I understand a small bit needs to remain generally).

As expected my doctor said we have to wait it out to see what happens. He was very understanding of my concern about but said we would have to wait for the scar tissue and swelling to dissipate and make a decision about it at my follow up in 2 months. And that he is very thorough with getting the gland out. 

I am attaching 4 pictures. The 1st two are the right and left when I would take my vest off within the first 1-2 weeks. The 2nd two are right and left at their most puffy since the surgery (a few days ago when completely relaxed). As you can see right after surgery the right side looked good and left side was a little off but nothing crazy. But after having the vest off for days the right was bad and the left looked absolutely terrible.

I asked if he thinks it's realistic to expect both to look like the right side did in the better pictures. He said he did think so and that I would be happy once everything had settled.

Personally I am skeptical because I can tell what the scar tissue feels like, more broad and smooth but still hard, and there is plenty I can feel in the surrounding area. What I feel on the left side under the nipple feels lumpy and glandular, exactly how I would expect the gyno to feel.

So I am definitely concerned about that. I realize I will have to wait and see and will continue massaging the area, etc...but has anyone here seen it look that puffy post surgery (4 weeks out tomorrow) and then be almost completely flat against the chest 3-6 months post-surgery like in the 1st set of pictures right side (left side even in the 'good' pics still bugs me)? The puffiness has been my biggest concern from the start.


Thanks a lot

[Dr. Elliot Jacobs]

It is less than four weeks from surgery.  "You still have many months of healing in front of you.  However, a few general points.

First, one cannot tell, by examination alone, if what you have is scar tissue or residual breast tissue.  I cannot determine that -- and I doubt that your hands can tell either.

Second, at least with my operations, puffy nipples should be flat and smooth and flush with the surrounding chest immediately after surgery -- if that surgery was done appropriately. If the nipples are still puffy immediately after surgery, then most likely there is residual breast tissue present.

On occasion, during the first 2-3 months after surgery, scar tissue can grow beneath the nipple and make it  seemingly puffy again.  In this case, the diagnosis is not made by feel but by the history and the time line.

Dr Jacobs

[Litlriki]

I agree with Dr. Jacobs.  It's common to see a little puffiness of the nipples during the early healing phase, especially after the vest is discontinued.  Prior to that, the swelling is controlled by the vest, and as you've observed, the chest contour was flat. Generally, this resolves completely over time unless the initial resection wasn't adequate.

One other point I would make--Although the photos you've posted are not really very good views, they do show your concern, and the little bit of puffiness there can be seen.  I often remind my patients, however, that no one has that view of your chest--except you.  I have had a few patients over the years complain about the shape of the nipple (when they look down), even though to my eye, the result is good.  Upon further probing, the bird's eye view issue is raised, and I remind them that the view they should be most worried about is the one in the mirror.

Rick Silverman

[David1991]

Thank you both for the replies.

Dr. Jacobs: It seems like there is a clear difference between what I am feeling on the left side under/around the nipple and everywhere else. Right under the nipple it feels bumpy like there are little lumps. Everywhere else where it has to be scar tissue it is equally hard but smoother and one solid chunk of tissue rather than this lumpy texture. This is what I feel but of course I can not say for sure what it is.

As for how it looked right after the surgery, I do not have pictures from the downward angle but attached are pictures about 3 days out, when I first took the vest off. I recall that the right side was pretty much perfect right after surgery (same day). The left side was much better but still pointed out a bit and therefore was my concern from the start. It has gotten worse with the swelling and scar tissue build up but yes right after the surgery the left side was still out a bit.



Dr. Silverman: While I agree that the angle seen by others is important, it is the case that looking down is when it looks it's worst and this is what I have to see every day. Really this surgery was at least as much so I could be happy with what I see, more so probably than what everyone else sees although of course both are important. So while I wouldn't complain if it looked perfect in the mirror but still a little off looking down I certainly am hoping for it to look good while looking down as well. I hope that is not unrealistic.


All in all I know I have to wait it out and see but I appreciate the expert advice you guys can give me. Very helpful.



Edit: for the record the pictures in this post have the nipples fairly contracted in the top pic. Then it's right and left side, not completely contracted or relaxed.

[DrPensler]

I would agree with my colleagues.In the early stages of recovery it is impossible to sort out the various possibilities. There can also be a small hematoma under the areola that is typically quite firm.The firmness does resolve but it takes several months.Also with a small hematoma the appearance can be identical to yours and it certainly can completely resolve.On the other hand you could have some retained tissue that may benefit with a small excision,not a big deal, often under local.Regardless of what the exact issue is the treatment is identical for all the possibilities,tincture of time.

[David1991]

Thank you for the response.

I've been massaging a lot lately. Things look better on the whole but still fluctuate throughout the day. As of right now my guess is that things will continue to improve but I will still be slightly unsatisfied with the left side, and the degree of my dissatisfaction will determine if I will get revision or not. It would be annoying to have to do but at the same time I imagine the hospital fees would be lower if it was a quick excision from the nipple as opposed to last time where I had to go under full anesthesia in the hospital for lipo + ultrasonic lipo + excision, although I do not know how different the hospital fees would be.

In any case that is speculative at this point and regardless I realize I will have to wait, but the replies here have eased my worries about as much as possible for the time being. Thank you