Puffy Nipple Recover

[camtransboi]

I just had surgery three weeks ago to reduce some tissue and puffy nipples. Right after surgery the nipples/areolas were flat and looked amazing. Now, they are back at being 'puffy'. People have mentioned that this can be due to scar tissue or other issues. My chest looks a lot better, but they nips/areolas are still puffy.

1. How long did it take for the nipples/areloas to settle into their final state?
2. Are there things I should/can do to speed up this process?
3. If a revision is needed, how long do I need to wait to let my chest settle post-surgery?

Cam

[Dr. Elliot Jacobs]

If your nipples looked good and satisfactory to you right after surgery -- that is important and that is probably the way you will look sometime down the road.  Characteristically, there is swelling after surgery so you may temporarily "lose" the correction.  Scar tissue along the incision as well as under the areola also contributes to the apparent swelling.

Best thing to do is keep the faith and be patient.  Perhaps some gentle massage would help (check with your surgeon on this to see it the wound has healed well enough to do massage).  Wearing a really snug compression garment can only help.

Healing is extremely variable and may take 2-6 months or even longer for the last amount of swelling to diminish.  Be patient,  trust your doctor and follow his advice.

Dr Jacobs

[greatdane]

I had surgery a month ago Cam and I'm in the same situation as you. Chest has flattened out completely but the nipples have puffed out a little. Right now it's a 50% improvement but there is  a lot of scare tissue there. Judging by other posts written about puffy nipples it should come as a surprise if the nipples had flattened out at this stage after your surgery.

[MSJ108]

How's it coming along? Any pictures?

[MSJ108]

If your nipples looked good and satisfactory to you right after surgery -- that is important and that is probably the way you will look sometime down the road.  Characteristically, there is swelling after surgery so you may temporarily "lose" the correction.  Scar tissue along the incision as well as under the areola also contributes to the apparent swelling.

Best thing to do is keep the faith and be patient.  Perhaps some gentle massage would help (check with your surgeon on this to see it the wound has healed well enough to do massage).  Wearing a really snug compression garment can only help.

Healing is extremely variable and may take 2-6 months or even longer for the last amount of swelling to diminish.  Be patient,  trust your doctor and follow his advice.

Dr Jacobs

Doc thank you for this post. Alot of people have been saying that they like the results right after surgery and then see some puffiness returning. I think this will help ease some anxiety people are having. Thank you sir!

[Dr. Elliot Jacobs]

You're welcome!

Just remember, sometimes there will be some scar tissue formed under the areola -- the treatment is NOT SURGICAL!  Surgery to remove scar tissue results in --- more scar tissue.  A judicious injection of a steroid (not the bad kind) will help to melt away scar tissue.  In general, I like to give Mother Nature a good 4 - 6 months before beginning steroid injections.  One or more injections may be necessary to achieve the desired effect.

Elliot Jacobs, MD, FACS

[Noseguard]

Dr. Jacobs,

The term "scar tissue" is used a lot on this board.  I am headed into surgery soon and I am confused what exactly that is.

What is scar tissue?

Is it different than the actual scar we can see on the surface?

Does it always go away?

Why does it vary so much from person to person?

Sorry for all the questions, I really don't think I understand this subject and that concerns me going into surgery.

Thanks!!!!

[Dr. Elliot Jacobs]

When the body is injured, it sets off a very complicated sequence of wound healing.  But ultimately, the body heals with scar tissue, which is different from the usual tissue of the area which was injured.  For example, if you know someone who has had surgery with an incision through the skin, that skin does not heal back as virgin skin again.  The tissue that you see on the surface is scar tissue.  If someone has very deep burns, the skin too will heal with scar tissue.   If you look at scar tissue under a microscope, it has a distinctive appearance and is the same from individual to individual.

The scar tissue that you see on the surface is, in fact, no different than the scar tissue underneath the surface!  In fact, when gyne surgery is performed across the entire surface of the chest, there will ultimately be a layer of scar tissue underneath in a layer across the chest as well.  (That is what makes revision or secondary surgery so difficult and why it behooves one to get the surgery done right the first time around).  Sometimes excess scar tissue forms in response to a small collection of blood, which can occur after surgery.

The body will eventually re-model the scar tissue, removing more of the scar tissue than what builds up -- but there will always be some layer of scar tissue present after surgery or injury -- forever.  That is why doctors will recommend observation and patience, and sometimes massage, in dealing with scar tissue -- it usually gets better by itself -- but it may take 6 months or more.

I trust this will answer some of your questions.

Elliot Jacobs, MD, FACS

[Grandpa Bambu]

Dr. Jacobs...

What an awesome post!

Me thinks Merle should have a FAQ board with your last post (word for word) included...

GB

[Blue2]

I agree! That was very informative. Thanks Doc. 

[Noseguard]

Yes Dr. Jacobs that answer helped to fill in the vast gaps in my surgery knowledge.

Thanks for taking the time to reply with such detail.

The combination sound medical input with real life experiences by gyne sufferers is what makes this forum special.

Appreciate it.

[MSJ108]

Dr. Jacobs...

What an awesome post!

Me thinks Merle should have a FAQ board with your last post (word for word) included...

GB

Amen to that brother

[gynebegone2]

Dr. Jacobs...

What an awesome post!

Me thinks Merle should have a FAQ board with your last post (word for word) included...

GB

That is the first time on this board, or even with a doctor that I have gotten a satisfying explanation of scar tissue that is easy to wrap my head around.  Well said!

[matthew1]

I agree! That was very informative. Thanks Doc. 

 Doc send  him a  bill for 250 for that answer 

[Dr. Elliot Jacobs]

Scar tissue can be large or small, like a marble or spread out -- extremely individual.  Please keep something in mind -- scar tissue is a normal bodily process of healing.  It's presence doesn't mean anything.  In general I would only treat scar tissue if it creates an abnormal contour.  If it exists only under the skin, and only you can feel it, then steroid treatment is not mandatory -- it is optional.  And remember, this is strong medication -- if your contours are good but you are bothered by the feel of the scar tissue, steroid injection can create a depression if it removes the scar tissue that is providing appropriate contour.

When scar tissue is in process of forming soon after surgery, there can be strange feelings of pulling, tightness, tingling, etc.  Best to bite the bullet with these because it will pass.  Stable scar tissue is usually "quiet" as regards these symptoms

Since gyne surgery is performed mainly to provide a smooth, flat, contoured chest, I usually recommend steroid treatment only if the scar tissue is contributing to a bulge.

This is only my personal opinion about approaches to scar tissue treatment after surgery -- other docs may differ.

Hope this has been of help to you.

Elliot Jacobs, MD, FACS

PS  no charge for the consult -- just glad to help!!!!