scar tissue and kenalog injections

[gemidude]

I am 5 months post op, and have been told by a dermatologist that I have nearly 2 centimeters of hypertrophic scar tissue in each chest. I am just wondering what to expect once I get a kenalog injection. How long before I notice results. I was really nervous, because I felt a large lump in both of my chests, but it felt too hard to be gland, but I'm glad it is just scar tissue!

[DrPensler]

First I would recommend you talk to your surgeon. I sometimes utilize kenalog injections postoperatively  ,BUT I INJECT THE  KENALOG! Kenalog  , a steroid, operates pharmacologically by decreasing the rate of collagen deposition directly  and increasing the rate of collagen resorption secondarily by decreasing the inhibition of collagen resorption. In any case the results take time, weeks to months, and the injections if there are more than one are separated.

[Litlriki]

I would echo Dr. Pensler--Your surgeon should do the injection if possible.  You should allow for time between the injections if you require more than one, since this is not without risk, and too much can cause problems.  I allow 6 to 8 weeks between them.

Rick Silverman

[gemidude]

Thank you all for the input, I probably was not clear. My surgeon IS definitely doing the injection. The dermatologist did not want to do the injection, for fear of indention in chest area, and she did not want to be held liable.

[Litlriki]

Smart dermatologist.

RS

[gemidude]

Ok so here's the deal. I went back to the dermatologist office, the person I spoke to last time was only a Physician assistant, but now I spoke to the actual dermatologist. They examined me and guess what, I don't have scar tissue, I have residual gland! Which means I will have to go for another surgery. My surgeon did not take out enough gland. I had a feeling scar tissue could not make my chest look this big! Any advice for me docs?

[DrPensler]

Your story is unfortunately all to  typical. I would recommend you see a surgeon who is experienced in performing gynecomastia surgery and secondary surgery for gynecomastia correction.

[gemidude]

What are most surgeon's policy on revisions. I do not want to go back to this same doctor again. Do I have a valid complaint, if I want to go to the medical board? Have surgeons offered full or partial refunds for this?

[Dr. Elliot Jacobs]

I find it interesting that the dermatologist told you that you have residual gland -- without actually having done or witnessed the operation.  Let me try to set the record straight for you.

If you were initially flat and contoured after surgery and if you have not done any anabolic steroids or taken any medications that might possibly cause gland to grow, then more than likely it is NOT residual gland (as the learned dermatologist told you) but rather scar tissue.  And assuming it is scar tissue, then you do not need another operation but rather expertly injected cortisone injections.  Let me be blunt:  even I cannot tell, by examination alone, what is breast re-growth and what is scar tissue -- they feel the same! So how would he know?

Therefore, rather than start looking to complain to a medical board or demand a revision or a refund, why don't you just return to your surgeon to discuss the situation and see what he can do for you?  Certainly, he knows what was done during the operation and would be best able to judge if cortisone injections or an actual surgical revision would be in order.

It is simply un-wise to seek an outside opinion about an operation from a doctor who doesn't even do this type of surgery.

Dr Jacobs

[gemidude]

Thanks, I am not going to complain. I am going to my surgeon, and ask for cortisone injections. I don't remember if I was flat after the surgery, because I was all taped and bandaged up. I doubt my surgeon, would have left that much gland after my surgery. But who knows, let's hope its scar tissue!

[Litlriki]

I could not have said it better than Dr. Jacobs! Even as a surgeon providing a second opinion, I would not be able to make a definitive statement of the sort your dermatologist did. 

RS

[gemidude]

After looking at some before photos, and taking some recent after photos, I have to say I am more then pleased with the results. Scar tissue or no scar tissue, my surgeon did a good job. These are some better photos that I took recently, and it seems my chest has flattened a little since this discussion started. What do you all think? The side photos look better than the front photo.
5 month post op-
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pre op-
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