Infection, Prolonged Swelling & Nipple Loss

[mell0w]

I'm told that infection is very rare following the procedure, but unfortunately I'm one of the unlucky ones.  I had my operation in late April 2011.  Only fat was removed because the doctor said that my glands were very flat.  I have four incision points below the chest area; there were no incisions around the areolas.  Four days later, I looked under my bandages and noticed a lot of redness and some small blistering.  The next day my doctor told me that I had cellulitis or a staff infection.  It was pretty severe, though I did not have a fever.  The infection appeared worse on my right side.  I had already been taking my antiobiotics, but more were prescribed and the infection abated within 10 days.  The problem is that now, almost three months later, I still have a lot of swelling on the right side of my chest and I have lost the nipple on my right side (the areola pealed off at about two weeks but has regrown without a visible nipple).

My doctor says that I will need to wait about nine months rather than the traditional six months to see the final results due to the infection.  At that point it might be necessary to have follow up work done.  The thought of this dragging out another six months only to possibly have another procedure is frustrating, to say the least.  I'm thinking about having it done in another three months.  I'm sharing this for anyone who may have gone through a similar experience, but I also have a couple of sets of questions for any doctors out there:

1. If hard, significant swelling is still present on one side of the chest three months later, how long is it likely to take to heal given that I had the infection?  What are my options to fix it?  (I am still wearing my compression vest anywhere from 16 to 22 hours a day until the hard swelling disappears, but should I do something more agressive?)

2. My doctor says that he has seen a nipple grow back on one of his patients before, but I feel like he's asking me to cross my fingers.  Is it likely my nipple will grow back?  If so, how long should I wait?  Is it possible I'll have to have skin grafted?  If so, should my doctor do this at a reduced fee?

Thanks for any advice you can provide.  To anyone out there with gynecomastia who is thinking about having the surgery, I still recommend it.  I was unlucky. Hopefully in the end it will have been worth it for me.  If I can offer any advice, it's to be vigilant about looking for infection at its earliest stages.

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I've added photos below.  You may not want to scroll down if you're squeamish.

[jojo82]

Where did the infection start? At the incisions made at the bottom of the breast or under the nipple where there was no incision? Losing a nipple is serious. If the doc doesn't do a revision for free, then you may want to consider going over the facts of what happened with a medmal attorney.

[mell0w]

Looking back at my pics, the infection does not appear near the incisions.  It appears in the areas around the areolas.  (I would post pics if I could figure out how.)  I suppose I'd like to know if the doctor is at fault, but I would much rather get the problem fixed than worry about lawsuits.  If I suspect it's his fault, I might just be more insistent that he does whatever it takes at no extra cost.

[jojo82]

Looking back at my pics, the infection does not appear near the incisions.  It appears in the areas around the areolas.  (I would post pics if I could figure out how.)  I suppose I'd like to know if the doctor is at fault, but I would much rather get the problem fixed than worry about lawsuits.  If I suspect it's his fault, I might just be more insistent that he does whatever it takes at no extra cost.

Can you post some pics?

Are you sure that was an infection rather than just adverse effects of poor surgery? Did your doc use laser lipo?

[mell0w]

Can I attach pics by uploading them from my hard drive or do I need to have a website link?  I can't figure it out...  Here is the description of his technique from his website:

"In addition to time-tested methods, he offers advanced surgical sculpting through the use of Smartlipo™ laser lipolysis. This new sculpting method is especially useful in removing smaller pockets of fat, and for fine-tuning the results of traditional liposuction procedures. Smartlipo uses a laser-tipped cannula, or medical wand."

I'm a little embarrassed to say I'm not sure what method he used.  I went with him because he had done the procedure many times before and had photos of positive results.  The other doctors I consulted with had never done this procedure.

[jojo82]

Can I attach pics by uploading them from my hard drive or do I need to have a website link?  I can't figure it out...  Here is the description of his technique from his website:

"In addition to time-tested methods, he offers advanced surgical sculpting through the use of Smartlipo™ laser lipolysis. This new sculpting method is especially useful in removing smaller pockets of fat, and for fine-tuning the results of traditional liposuction procedures. Smartlipo uses a laser-tipped cannula, or medical wand."

I'm a little embarrassed to say I'm not sure what method he used.  I went with him because he had done the procedure many times before and had photos of positive results.  The other doctors I consulted with had never done this procedure.

I asked because I saw photos of a man that had blisters from laser lipo because he had internal burns and swelling. But if your doc said it was an infection, it was an infection most likely.

You can insert the image on the forum by clicking the "insert image" button (right above smiley faces) when posting.

[mell0w]

I'll try to post a photo of the right side of my chest six days after the procedure here:



The blue line around the perimeter was drawn to make sure the infection didn't spread.

[mell0w]

And here is a photo of the right side three weeks after the procedure:

[mell0w]

this is my most recent photo at 7 weeks post op (2-3 of weeks ago):

[jojo82]

Maybe one of the docs here can comment on the first pic you posted.

Did your surgeon make an incision right across the nipple or what is a peri-areolar incision?

[mell0w]

There was no incision near the areola.  I had/have inverted nipples (a second blessing) but it became grotesque looking with the swelling from the infection.  The nipples used to come out when I was cold, etc...  Now the right side nipple is gone and the left side stays out (possibly due to swelling behind it).

Here's a photo of the left side after 7 weeks (there was infection on this side too, but it wasn't as bad):

[Dr. Elliot Jacobs]

There are a lot of questions that I cannot answer.  However, infection is something that can occur in any surgical procedure.  You did have antibiotics on board to begin with -- and yet the infection occurred (probably with a  bug that was resistant to that antibiotic).  Infection can result in swelling and even tissue necrosis (if severe).  Fortunately for you, it was recognized and treated appropriately.  The resultant firmness and swelling may be a result of the infection -- and may take many months to soften and settle down -- be patient.

If indeed Smart Lipo was used, there is a possibility that the laser aspect of it may have contributed to your skin problem -- but there is no way to know conclusively.

Fortunately, infection in gyne surgery is exceedingly rare.

Sorry for your misfortune -- but happily, you are now on the road to recovery.

Dr Jacobs

[jojo82]

I have to add that I am very sorry this has happened to you. The result, sans the nipple, is actually not bad. Nipple loss is one of the complications of gyne surgery, and it's a complication that some doctors explain to patients (most I have interviewed mention it to patients). However, if you feel that the loss of your nipple was due to negligence or the particular technique the surgeon used (laser lipo has a lot of additional complications), then I stand by what I said earlier- consider talking to an attorney about what happened. But losing a nipple is not unheard of. And I feel that as a consumer, you are entitled to free revision surgery. Unfortunately, consumers of plastic surgery are at a real disadvantage in the information war. If you contact me, I may be able to help you if you cannot get help from your surgeon.