I had my first surgery 2 years ago for gynecomastia. In the following weeks I was very happy with the results. Chest was very flat. Then after I was able to quit wearing the compression vest (i don't remember how long it was exactly, but it was a few months), it seemed that my results got worse.
1 year later I addressed this with my doctor, who said that there was no more gland, and that it was loose skin. She had done very minor liposuction in the areas that were loose in hopes that the skin would adhere more to the chest wall. This did not work.
2 years after my initial surgery, I spoke with my original doctor again about my puffy nipples. I told her that it still felt like there was some sort of gland under my right nipple. When I got to the doctors office she examined my chest thoroughly and determined that I still didn't have any gland underneath and that it was in fact loose skin. She was surprised that this had happened and had not seen it before with someone my size and age. I just have bad genetics when it comes to skin elasticity.
After much consideration, she decided that she would cut very minor pieces of sking from each side of the nipple.
So far the results look pretty good. WAY better then the loose skin/puffiness of my nipples. I'll post the pictures in a couple weeks after swelling has gone down.
But, here are all the pictures for the past couple years. If the doctors could look at them and give me incite on why my results looked good at the start and got worse over time. Oh, and if you can or can't tell by the pictures, I have actually gotten in way better shape then when I had my initial surgery 2 years ago, so weight gain couldn't be the issues IMO.
Thanks!
When evaluating patients with Puffy Nipple Complication After Gynecomastia Surgery, my Standard After Gynecomastia Surgery pictures are a good starting point. The Standard Videos the next step. Beyond that the in office exam is the most critical. Arm position on the chest is a factor in understanding loose skin, but in some cases, bending over views can show some loose skin factors.
As discussed on that publication, the deformity can be remaining gland, scar tissue, surrounding Crater Deformity, and loose skin. I have seen some variations that had loose skin over a crater that I then coined a Bursa Crater Defect. The first individual that came from Canada was smart enough to say that the pictures just did not show the problem. He was right on target. He came into the office and the deformity found was documented and revised with nearby resources.
Which components alone or in combination will not only vary from patient to patient, but sometimes from one side to the other. Removing local skin is rarely the best option especially if a skin draping problem is the heart of the matter. When skin reduction is done in a male, unless there are permanent balancing forces left to keep the nipple small, you can end up with the Massive Nipple Deformity that I also showed.
When possible, choose a solution that someone has been able to actually demonstrate works for that problem. If something works, there should be before and after pictures demonstrating that it works.
Check my responses to your prior requests for help here:
https://www.gynecomastia.org/smf/index.php?topic=23360.msg155326#msg155326If there is an underlying cause for the gynecomastia, surgery does not prevent further breast growth. I have seen that when other surgeons did not stabilize a problem first, operated, and the problem actually got worse than what that surgeon started with. So if the breast is growing and now worse, the starting point is not surgery, but establishing if the problem is stabilized.
Hope this helps,
Michael Bermant, M.D.
Topic: why did good result get worse over time (lots of pics) (Read 4968 times)
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