Scar Tissue

[jimmy1234]

Had my 2nd revision done today and it was mostly due to puffy nipples. The PS told me after that the reason my nips were puffing out was because of a build up of scar tissyu. He showed me the actual tissue that he removed and there was a chunk of it.I asked him if it were possible that this could happen again. He said it was possible but he sis not think it would because he removed enough below the nipple that it would make even if tissue did form it would not push the nipple out but said it could be treated with cortizone so keep an eye on it. First of all what are the chances of tissue forming gain and secondly what would cortizone do to minimize it's effect. Also I just had a look at my gauze and it looks like it bled out a little bit. He did make sure that ther was no bleeding before I left. How much blood is normal and should i be concerned

[Dr. Elliot Jacobs]

A few drops of blood on a post-operative dressing is normal and nothing to be concerned about.

Am I correct that this is your second revision -- making it three operations already?

Scar tissue is the way the body heals from surgery.  For some reasons, there does tend to be more scar tissue formed under the areola.  I would certainly apply as much pressure on the areas as feasilbe by using a compression garment.  Keep a close eye on the area and keep in close contact with your surgeon.

Should new scar tissue form, then consider a steroid injection, such as kenalog.  The problem with cutting out scar tissue is that you will heal with more scar tissue.

Dr Jacobs

[DrBermant]

Had my 2nd revision done today and it was mostly due to puffy nipples. The PS told me after that the reason my nips were puffing out was because of a build up of scar tissyu. He showed me the actual tissue that he removed and there was a chunk of it.I asked him if it were possible that this could happen again. He said it was possible but he sis not think it would because he removed enough below the nipple that it would make even if tissue did form it would not push the nipple out but said it could be treated with cortizone so keep an eye on it. First of all what are the chances of tissue forming gain and secondly what would cortizone do to minimize it's effect. Also I just had a look at my gauze and it looks like it bled out a little bit. He did make sure that ther was no bleeding before I left. How much blood is normal and should i be concerned

So everything went ok. The gland did not grow back which is what i had feared buy as it turned out there was a formation of scar tissue that lumped underneath my nipples forcing them to puff out a little. What are the chances of the scar tissue coming back and if so is there anything I can do to alleviate the chances.

Residual gland will look just like scar to the eye (even with surgeon's magnification). Under the pathology microscope, glandular tissue has always been a factor in the many revision surgeries I have done from other doctors.

Scars after gynecomastia surgery depend on the problem to be treated, skills of the surgeon, surgical techniques, Scar Care, Compression Garments, and many other factors.

Prevention is much better when possible.  Some surgeons just damage tissue more resulting in greater swelling, damage, and potential scarring. Prevention of such scars can be a function of choice of surgeon. I prefer techniques the have less swelling, bruising, and easier healing after gynecomastia surgery. It is quite rare that my patients need steroid injections after surgery to manage their scars.  I have seen videos of some doctors' surgery burning away tissue with high cautery settings that make for quicker surgery but more damage.

Patient selection is another factor. Some patients tend to develop such bad scarring, that elective surgery is not a good option.

Such questions are better directed to your doctor who is familiar with the problem and what was done.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[jimmy1234]

So is impossible to keep my nipples from puffing out. I mean if it just heals with more scar tissue under the areola what's the point.man this is starting to get more and more hopeless

[DrBermant]

So is impossible to keep my nipples from puffing out. I mean if it just heals with more scar tissue under the areola what's the point.man this is starting to get more and more hopeless

Depending on what was done and other factors, I have been able to revise puffy nipples from other surgeons' techniques as demonstrated in the links I posted above.  Some patients do have bad scar problems, and revision surgery has little to offer. Such issues are best explored during a consultation or evaluation. 

Hope this helps,

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

[jimmy1234]

thanks. and also my PS said that a compression vest wasn't necessary that a very tight under armour shirt would do. Does this sound about right?

[DrBermant]

thanks. and also my PS said that a compression vest wasn't necessary that a very tight under armour shirt would do. Does this sound about right?

No, not for my patients, nor my techniques. Each doctor has his / her own methods. Results on my website are for my techniques. You should validate your doctor's recommendations with their own examples.  If interested in learning more, we are glad to help patients explore concerns and options during a consultation.

Hope this helps,

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

[jimmy1234]

So you feel that I should be wearing a compression vest?

[DrBermant]

So you feel that I should be wearing a compression vest?

I am glad to express what I feel any specific patient should do during a consultation or a Preliminary Remote Discussion where I can develop an appropriate doctor patient relationship, learn enough about the situation to form a valid opinion, and then take the time to explain the risks, benefits, and alternative methods of care.

Hope this helps,

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

[jimmy1234]

went back and everything went good and looks ok. My ps told me to tpe down my areolas and that way it should stop the scar tissue from building. My left side I can feel a little bit more soreness and it feels a little swollen but not too much. Is it the swelling that creates the scar tissue?