Post surgery questions

[bigj1207]

I had surgery June 11th of this year, and so far Id say I'm about 60% satisfied. It was performed by Dr. Jacobs in New York, NY. I had found him from reading these post and researching the best gynecomastia surgeons around where I lived. But neway to get to the point. After surgery I had seen Dr Jacobs a few days later and he said I had a hematoma on my right side and that it would eventually go down. (For those that dont know what a hematoma is, he said that its kinda like a blood clot that makes your skin discolored and also swells and hardens the area. The discoloring eventually went away but the swelling and the hardening of the chest has yet to go down.

So I was wondering if any of you guys have had a hematoma, and if so did it go away, how long did it take, and what did you do to get rid of it?

Also on the left side there is lump under neath my chest and Dr. Jacobs said that it was from wearing the compression vest wrong and that it would go away shortly but that also still hasnt gone away even though I am massaging it daily the hematoma has also made my right nipple all puffy and hard. If anybody has any advice or experiences of the same thing let me know

[DrBermant]

I had surgery June 11th of this year, and so far Id say I'm about 60% satisfied. It was performed by Dr. Jacobs in New York, NY. I had found him from reading these post and researching the best gynecomastia surgeons around where I lived. But neway to get to the point. After surgery I had seen Dr Jacobs a few days later and he said I had a hematoma on my right side and that it would eventually go down. (For those that dont know what a hematoma is, he said that its kinda like a blood clot that makes your skin discolored and also swells and hardens the area. The discoloring eventually went away but the swelling and the hardening of the chest has yet to go down.

So I was wondering if any of you guys have had a hematoma, and if so did it go away, how long did it take, and what did you do to get rid of it?

Also on the left side there is lump under neath my chest and Dr. Jacobs said that it was from wearing the compression vest wrong and that it would go away shortly but that also still hasnt gone away even though I am massaging it daily the hematoma has also made my right nipple all puffy and hard. If anybody has any advice or experiences of the same thing let me know

Posting Standard After Gynecomastia Pictures can help other better understand your concerns.

Hematoma After Gynecomastia Surgery can happen, it is a complication that any experienced surgeon has faced. Hematoma are very rare in my practice, we are down to one every few years.  They are not totally preventable.  The body needs to deal with the blood in the tissue.  It can go away completely or remain as a firm mass.  Part of the art of Plastic Surgery is to minimize trauma to help with healing.  Healing is just slower after a greater injury, so a side with hematoma will lag far behind the other without.

Time to tissues softening can vary depending on the original problem, what was done, after surgery care,
Scar Care, After Surgery Compression Garments, and many other factors. Options depend on the problem to be treated. Time can range from 6 months to a year but can vary depending on many issues best explored with your doctor.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia Surgery

[Dr. Elliot Jacobs]

I am making an exception and replying to the patient because I feel that BOTH sides of this story have to be told.

This patient lives in an neighboring state, about two hours from my office.  That is fine -- I frequently operate on patients who live a distance away -- or even half way around the world.  But appropriate followup is very important -- and I insist on it -- but only if the patient cooperates and comes back to my office.

First, any bleeding is of course stopped during surgery.  No surgeon would ever let a patient leave the operating room with an active bleeding situation.  Second, in my office, the patient is routinely observed and checked for bleeding for a minimum of two hours before he is discharged -- again he was fine.  Next, I always call my patients -- personally -- on the night after surgery just to check on them. Again, he was fine.  He was scheduled to return to my office for a follow up visit a few days later.  I do this to check the patient and to make sure he is wearing the compression garment properly.  He canceled that appointment and said everything was fine and that he would return as best possible.

It was not until ten days after surgery that he called to say that his right side was firmer than the left -- and I told him to come into the office ASAP.  He came in the next day, 11 days after surgery!  I do not know if he followed my post-op instructions during those first 10 days -- especially when I request absolutely no strenuous activities (which can start a bleeding problem days after surgery).

He FIRST returned to my office on the 11th day after surgery -- and had a small hematoma on the right.  A hematoma is a collection of blood under the skin.  Of course I immediately put a needle into it (there is no pain because the skin is still numb after surgery) and pulled out a small amount of blood (there wasn't much).  But with any hematoma, there is some blood which infiltrates into the surrounding area and which cannot be removed by a needle -- this requires the body to remove it.  And the body does remove it -- but it takes time (months) and it produces swelling and sometimes scar tissue.  He was also wearing the compression garment improperly -- so loose that it did not provide the proper compression which might have prevented the hematoma.

This case illustrates why proper and close follow-up soon after surgery is so very important and why following a doctor's instructions and wearing the compression garment properly are also very important.

A hematoma in my practice is extremely rare -- and it disturbing to me as well as my patient. This patient will eventually be fine -- the excess swelling on the right will diminish but it will take time (months).  Any firm tissue on the left is scar tissue and will respond to massage and/or kenalog.  And eventually he will be 100% pleased.

A hematoma is obviously not desirable -- but if it is caught early it can be treated and the post-op course made easier.  As I tell my patients, this is a side-ways step -- not a backward step.

Bottom line:  close follow up with your surgeon, wearing a snug compression garment, and following your surgeon's instructions will all help to minimize problems after surgery.

Dr Jacobs

[bigj1207]

I Just want to make it clear for anyone who is reading this post. By no means I am trying to bash or state that Dr. Jacobs did a bad job with the surgery. He is a great doctor I would recommend him to any one having a gynecomastia surgery. I realized that the healing process takes time and I will not see the ending results until about a year. I have had plenty of surgery's in my life, and this first time Ive ever been able to access a discussion board and speak with other people who have had similar surgery's. So all I was trying to do was post my story and see if anyone had went through the same type of situation and see how that ended up, But again I just want to reiterate the fact that the first post that was written was not made in a malicious manner or to knock Dr Jacobs, he was great, and if you go to his website you'll realize that his work speaks for itself.