Uneven results

[xvipx]

Hi, I had gyno (fat removal/lipo) surgery 6 1/2 months ago.  My results have been uneven since day 1.  My left side is bigger than the right.  I took the oral arnica to help with the swelling.  There was a lot of swelling for a while which is pretty much gone.  Maybe a slight bit of lumpiness in the bigger side when I push on it from the lateral side.  I wore a compression vest for about 2 weeks and then the doc told me I didn't need to wear it anymore.  I haven't done much massaging since I didn't know it was necessary and my doc said I could massage but didn't stress it.  I went to see him a couple of weeks ago and he said that I should come back in 6 months and that they will never be perfectly even but he will do something under local anesthetic the next time if needed.  I am not happy with the left side and want to know if waiting a few more months could give me get better results and that if massaging every day from now on can help me at this point.  Thank you.

[Litlriki]

Sorry to hear about your disappointment with the surgery.  It's difficult to say anything definitively without seeing your pre-op condition and how things look now.  Asymmetry is not unusual, and it can be based on a number of factors that are not related to the surgery itself.  For example, some men have a bigger pectoralis muscle on one side than the other. Sometimes, the rib cage is asymmetric, and this can cause it to look different.  On the other hand, sometimes it is related to the surgery: not enough tissue is removed from one side or there is bleeding with prolonged swelling on one side compared to the other.  These are probably the two most common scenarios. 

If the issue is that more tissue needs to be removed, that can certainly be done as a touch-up procedure, and I typically like to wait 9 months to a year to do that.  My rationale is that in some cases, the issue is not too much tissue left behind, but the second option--that there is prolonged swelling on one side, usually due to a little bleeding, which wouldn't actually have been considered a "hematoma," but rather, just results in a minor difference.  Sometimes you might see a little more bruising on one side, but not anything significant...and if that's the side that is bigger, it's due to that prolonged swelling. If I'm pretty sure it's not related to prolonged swelling, then I might do something sooner, though that would be very rare.

At this point, I'd probably encourage you to massage and follow-up with your surgeon as scheduled in six months.  Feel free to post photos or provide additional information, in which case my opinion might change a little.

Rick Silverman

[DrBermant]

Hi, I had gyno (fat removal/lipo) surgery 6 1/2 months ago.  My results have been uneven since day 1.  My left side is bigger than the right.  I took the oral arnica to help with the swelling.  There was a lot of swelling for a while which is pretty much gone.  Maybe a slight bit of lumpiness in the bigger side when I push on it from the lateral side.  I wore a compression vest for about 2 weeks and then the doc told me I didn't need to wear it anymore.  I haven't done much massaging since I didn't know it was necessary and my doc said I could massage but didn't stress it.  I went to see him a couple of weeks ago and he said that I should come back in 6 months and that they will never be perfectly even but he will do something under local anesthetic the next time if needed.  I am not happy with the left side and want to know if waiting a few more months could give me get better results and that if massaging every day from now on can help me at this point.  Thank you.

For my patients I use After Surgery Compression Garments much longer than two weeks. I use a Stage 1 Gynecomastia Surgery Garment during the protective Stage 1 of healing. I then use a Stage 2 Garment for the scars. Scars that evolve under pressure do much better than scars without pressure.

Scar Care is best early in the evolution of tissues. Once scars have stabilized, late term scar care seems to work less.

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

Early after surgery swelling can mask residual deformity.  How Tissues Evolve After Gynecomastia Surgery depend on many factors. Firm tissues after surgery can be residual gland, fat, but also can just be healing tissues or scars.  Different surgical techniques injure tissues to different degrees. 

I see many patients who complain of residual "Swelling" Puffy Nipple Gynecomastia after another doctor's surgery.  There are many possible problems causing such a deformity.  The most common is remaining gland behind the areola as seen in these Anatomy of Puffy Nipple Drawings.  Check out the images with the link for remaining gland after surgery to see what I mean. 

Here are just a few of the many examples I have seen and treated:

• Revision Gynecomastia After Failed Liposuction By Other Surgeon
• Revision Puffy Nipple Gynecomastia After Failed Liposuction By Other Surgeon
• Revision Gynecomastia After Liposuction and Partial Gland Excision By Other Surgeon.
• Revision Gynecomastia After Partial Gland Excision
  

The body typically needs to heal before considering revision surgery. Rushing into secondary surgery can be a mistake unless there are complications that need to be addressed or the next surgery is component of a staged procedure.  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 Chest Sculpture

[xvipx]

Thanks for the replies.  I guess I will wait to see if it gets better.  I was thinking about getting a little personal massager from Brookstone to help since I don't know the exact way to massage.  Please let me know if this looks like an OK product to use and how long I should use it each day.  Also any tips on how to hand massage would be great.  Thanks again.

http://www.brookstone.com/handheld-massagers_buzz-mini-vibrating-massagers.html?bkiid=subCategoryLandingPage_Massage_Personal_Massagers_Handheld_Massagers|C4CategoryProdList1FDT|6810625

[DrBermant]

Thanks for the replies.  I guess I will wait to see if it gets better.  I was thinking about getting a little personal massager from Brookstone to help since I don't know the exact way to massage.  Please let me know if this looks like an OK product to use and how long I should use it each day.  Also any tips on how to hand massage would be great.  Thanks again.

No, not for my patients. That would be way too traumatic on healing tissues! Scar care instructions should come from your surgeon.  Patient education is a hallmark of good surgery.

Hope this helps,

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