How to identify what is scar tissue, swelling, a seroma or a hematoma?

[BobGreggary123]

Four days after having gynecomastia surgery, I've noticed there is a is a slightly hard, tender lump, situated between my RHS areola and under-arm. I would say it's probably about as hard as pressing against the venus point of your palm. If I press one hand against the lump and then raise my arm till its above my head, I think I can feel some blood vessels being stretched and what feels like fluid moving/popping? (no-idea to be honest). What exactly is this?

More importantly, how can I distinguish between what is scar tissue/swelling/seroma/hematoma? (Any biology websites are welcome)

Thanks a lot

http://i.imgur.com/Gp06vyi.png

[thegynoman]

I am 15 days post op. As u have mentioned, exactly i have the same thing above my left chest areola...small lumpy mass, very hard and tender. But the overall contour is flat. A slight unevenness is there on that side. I sent some pics to the doc. He said its normal swelling and it will subside within a month. Similar to yours, while raising my arms above 120 degrees it feels like my ribcage muscles are pulling the arms down. Its not exactly a pain, but a strong pulling or locking kind of feeling as if my chest sides are not allowing the arms to raise up vertically. I asked the doc about this as well and he said it will normalise by third week. Lets wait and watch!

As per my limited knowledge:

Seroma: u can feel fluids flowing under the skin while massaging and there will be a bulge.  till now i don't have it.

Swelling: thats normal and will go away in a month or two.

Scar tissue: its like a hard lump when you lift your nipple. My doc said, just forget about scar tissue for 3 months post op. Now concentrate on massaging and check for any seroma formation. Scar tissue forms after 3 months, and if it forms then he has some injections for it and it will definitely flatten it.

[Stevew87]

I'm almost 4 weeks post op and that chest/ribcage thing i feel. It almost feels like tight muscles... like tight hamstrings not letting you touch your toes but it isn't painful i just feel a pulling sensation.

[BobGreggary123]

I am 15 days post op. As u have mentioned, exactly i have the same thing above my left chest areola...small lumpy mass, very hard and tender. But the overall contour is flat. A slight unevenness is there on that side. I sent some pics to the doc. He said its normal swelling and it will subside within a month. Similar to yours, while raising my arms above 120 degrees it feels like my ribcage muscles are pulling the arms down. Its not exactly a pain, but a strong pulling or locking kind of feeling as if my chest sides are not allowing the arms to raise up vertically. I asked the doc about this as well and he said it will normalise by third week. Lets wait and watch!

As per my limited knowledge:

Seroma: u can feel fluids flowing under the skin while massaging and there will be a bulge.  till now i don't have it.

Swelling: thats normal and will go away in a month or two.

Scar tissue: its like a hard lump when you lift your nipple. My doc said, just forget about scar tissue for 3 months post op. Now concentrate on massaging and check for any seroma formation. Scar tissue forms after 3 months, and if it forms then he has some injections for it and it will definitely flatten it.

Thanks for your help man! Could definitely be swelling, though the actual size and tenderness of the lump doesn't seem to be changing from when I initially noticed it last week, so am a bit uneasy. I'll give it another week and see if it subsides

[Dr. Elliot Jacobs]

There are a number of possibilities --many of them dependent on the time line.  For example, if there is a lump only 4 days after surgery, in no way can it be scar tissue -- it just doesn't grow that fast.  A small, tender, isolated lump anywhere on the chest may be a small, localized hematoma.  Sometimes these occur after the patient has left the operating room.  Assuming it is small, it should slowly disappear by itself.
Swelling alone usually isn't very tender.
If there is significant tenderness and tightness, there is a possibility that the liposuction cannula (assuming lipo was performed) may have entered the muscle.  This can be tender and can also produce some localized bleeding.  This, too, should improve slowly with time.
Best to be patient and contact your surgeon for follow up.
Self exam can be very misleading.
Dr Jacobs

[thegynoman]

There are a number of possibilities --many of them dependent on the time line.  For example, if there is a lump only 4 days after surgery, in no way can it be scar tissue -- it just doesn't grow that fast.  A small, tender, isolated lump anywhere on the chest may be a small, localized hematoma.  Sometimes these occur after the patient has left the operating room.  Assuming it is small, it should slowly disappear by itself.
Swelling alone usually isn't very tender.
If there is significant tenderness and tightness, there is a possibility that the liposuction cannula (assuming lipo was performed) may have entered the muscle.  This can be tender and can also produce some localized bleeding.  This, too, should improve slowly with time.
Best to be patient and contact your surgeon for follow up.
Self exam can be very misleading.
Dr Jacobs

Dr Jacobs, lets assume one has a minor/insignificant seroma or haematoma, and in the worst case if he doesn't aspirate it and leaves it as it is, then will it affect the final results in the long run? Will this small seroma/hematoma transform into hard scar tissues after 3-4 months? BTW my doc said he has injections to fix the scar tissues but after 3 months. 

[Dr. Elliot Jacobs]

Oftentimes patience is a virtue.  The human body has a wonderful ability to heal itself.

While the presence of blood can predispose to scar tissue formation, one cannot predict how much scar tissue may form.  Several months from now, if there is a palpable firm mass/lump, then your surgeon may opt to treat it with some cortisone injections.  

However, time and some massage may make further intervention unnecessary.

Dr Jacobs

[thegynoman]

Oftentimes patience is a virtue.  The human body has a wonderful ability to heal itself.

While the presence of blood can predispose to scar tissue formation, one cannot predict how much scar tissue may form.  Several months from now, if there is a palpable firm mass/lump, then your surgeon may opt to treat it with some cortisone injections.  

However, time and some massage may make further intervention unnecessary.

Dr Jacobs

Thanx Dr Jacobs! yes i am religiously massaging my chest as advised by my doc. The problem is I am 1000 km away from the doctor otherwise he cd have easily known whats going on with the swelling. Anyway that swelling is minor and I am much relaxed and will wait the swelling to come down. However, in the worst case of scar tissue formation, he always has the injections at 3 months.