Questions about scarring, anesthesia, and more...

[nyce]

Scarring

Scars vary, but I'm a bit concerned of my upcoming surgery when looking at my existing scars.  On my left shoulder, I developed a keloid scar from a burn from a cigarette (impressionable teens do stupid things).  It was an elevated lump that I later in life attempted to have removed.  The result was a broader, yet flat scar.  On my palms, two different incidents left scars that are noticeable, but nothing extreme.  If they were on my chest, however, I think they'd certainly draw question.  Should I be concerned?


Anesthesia

I was given the choice to have my surgery done under local anesthesia.  I quite prefer it to general anesthesia (even the twilight sleep method), as I've read there are more risks with general than local and being sedated is a bit unsettling.  That said, I also went to a different surgical consultation and when I inquired about having the surgery performed under local anesthesia, the doctor responded "Not on my watch."  Is there reason to not be under local anesthesia for this kind of surgery?  Is it just that the patient will be awake and aware of the procedure (cutting, etc.) being performed?


Compression vests

Does the need and time for a compression vest vary from patient to patient?  I've seen post-op pictures of people wearing rather intense bandages, but it seems these are for more severe gynecomastia cases.  In my consultation, the post-op support would be roughly 5 days with, from what I can tell from video clips on youtube, a rather light ace bandage and no direct chest exercise for upwards of 4 weeks.  Do others have opinions on this?  (My pics https://www.gynecomastia.org/smf/index.php?topic=22999.0)


Choosing a surgeon

I've been to 3 consultations over the course of ~3 years.  After finding this board, I was hoping to get in w/ Dr. Jacobs (I'm also in NYC), but his availability was unfortunately after my scheduled surgery.  I've been putting the surgery off and have finally, after my 3rd consultation, decided to go through with a doc up in West Chester, NY.  I feel comfortable in that he is board certified, focuses primarily on gynecomastia cases, and has tons of photos to demonstrate his abilities.  I want the best possible outcome and want to make sure I've given this enough time and attention to help ensure that.  Is there anything else I should consider?


Thanks in advance!

[Litlriki]

It sounds like you've done a lot of your homework.  To address your questions:

Scarring - The character of your shoulder scars is actually typical of shoulder scars, as well as the nature of the original injury (a burn).  This is not clearly predictive of the scars that might form from a surgical intervention such as gynecomastia surgery.  For one, the location of scars for this surgery allows for the scars to be better hidden than a burn on the shoulder. Also, in the majority of patients who do not have a genetic predisposition toward bad scars, these scars fade very well and are barely perceptible over time. 

Anesthesia - I used to do all of my procedures with conscious sedation or "twilight sleep," and if your surgeon is comfortable with this approach, I found it to be adequate.  I'm less enthusiastic about straight local anesthesia, since it may limit your surgeon if you're not able to tolerate the surgery, and he or she doesn't have the ability to use medications to make you more comfortable.  If you suddenly find that you're jumping off of the table due to discomfort, your surgeon only has the option of trying to use more local, or you would need some way to get pain medication and sedation on board quickly, and that is not usually achievable without an intravenous option.  If you're young and healthy, general anesthesia has very low risk.  As any anesthesiologist will tell you, your drive to and from the hospital is far more risky than your anesthetic!

Compression vests - I use compression for 4 weeks.  Some surgeons go for longer.  Some don't use compression.  I think that all of the surgeons on this forum use compression.  As for vests versus ace wraps, I find that the ace wraps don't stay in place, nor do they give even compression.  Over the weeks after surgery, it's difficult to put them on alone, whereas a vest can be taken on and off independently and usually provide even compression.

Choosing a surgeon - It sounds like you've found someone who does a lot of gynecomastia surgery, so as long as you're comfortable with him as well, and you've seen good results in his patients, you should be all set. 

Good luck.

Rick Silverman

[DrPensler]

With respect to the scarring some patients develop more noticeable scars ie hypertrophic scars and or keloids. Having said that abnormal scarring is relatively  rare. The shoulder is a particularly bad area for  hypertrophic scars by the way.
I prefer conscious sedation ( twilight ) but have used local at patients request. This is something to discuss with your surgeon.
The compression garment varies with respect to surgeon and the needs of each patient/ again go with what your surgeon recommends.
Jay Pensler,MD

[nyce]

Thanks for the replies.  I'm a bit nervous about having chosen to not get general anesthesia, but seeing how the entire area will be numbed for the incisions as well as the liposuction (right?) what I am able to feel should be very minimal.   

Just curious, why was my doctor's name removed?  I've seen several other doctors' names listed, no problem.

[Litlriki]

I'm not sure why your surgeon's name was removed.  Most of the names I've seen are those of the supporting surgeons.

RS