SEROMA and SCAR TISSUE (Dr. Elliot Jacobs)

[kongking]

I had gynecomastia surgery exactly 6 weeks ago and now there's a lump on the lower right portion of my right chest (making my chest look bigger than before the breast glands were removed). I've noticed the lump as early as 10 days after my surgery, and I still don't see any change in its appearance. Also, the surface of the lump feels numb when lightly touched; it is soft when pressed, kinda like fat.

I had my post surgery check up a week ago, and my doctor said everything's fine and I'm healing well and that although the chest is still swollen, it's not seroma.  However, I can't help but feel that it is seroma and that the surgeon just didn't notice because of the bad lighting in the consultation room (not bright enough).  I also read somewhere in here that if seroma isn't aspirated or treated properly, it will delay healing and may cause scar tissues to form.

So my 1st question is: How do I know for sure that the lumps on my chest is mainly swelling and not seroma?  Can I have a chest ultrasound or any other procedure done to make sure?

[kongking]

2nd Question:  How soon after having surgery can I have kenalog shots to remove scar tissue? or how long do I have to wait til I'm sure that the scar tissues underneath my chest will no longer go away without steroid injections? 

The reason for my question is that I'm pretty sure I have scar tissue formation underneath the skin below my left nipple (this area used to be my problem area and my surgeon said he took out breast tissues in this area).  However, when I consulted with my surgeon, he told me that any scars underneath will go away in time and he only injects scars that are very noticeable such as scars on the nipple areola; moreover, he does NOT administer steroid/kenalog for scars beneath the skin. The reason I call out Dr. Jacobs is because he seems to have the most comments / experience when it comes to scar tissues and steroid shots (based on what I've read in this forum).

Scarring below my left nipple is distorting the otherwise good result of my surgery and I would like to make it go away.  Also, my fear that the possible seroma in my right chest leading to the formation of scar tissue, will also not bother me as much if I know that any scar tissue can be rid by steroid shots.

[Dr. Elliot Jacobs]

Sometimes it is difficult to differentiate between swelling and seroma.  Both ultimately disappear over time.  Seroma is a collection of fluid in a space while swelling is just fluid inbetween the individual cells.  Sometimes, if I am not sure, I may just put a needle into the perceived area of seroma and try to withdraw some fluid.  If fluid comes out, it is a seroma.   If nothing can be removed, then it is swelling.

As for scar tissue, I do not inject kenalog until at least 3-4 months or more have elapsed since surgery.  Reason:  some of what you feel may indeed be localized swelling (in which case it would diminish spontaneously) and sometimes it is early scar tissue, which may diminish with some massage.

Dr Jacobs

[kongking]

Thank you for your answer Dr. Jacobs!

[kongking]

Doctor,

Should I insist that my surgeon put a needle in the lump to try aspirating any fluid? What I mean is, IF the lump is indeed seroma, would aspirating make a difference on how fast and how well the site heals?

Also, do you suggest I try massaging anything I perceive as scar tissue 4 months after my surgery, and if the scars don't get better, I visit you around 6 months post surgery?  Thanks.

[Dr. Elliot Jacobs]

You could perhaps bring it up with your surgeon in discussion -- but would leave it up to the surgeon to make the decision.

As for massage, that too should be discussed with your surgeon.

I am not your surgeon and cannot provide specific advice for you -- sorry.  I can only comment in general.

Dr Jacobs

[kongking]

Greatly appreciate your responses Dr. Jacobs.  Thank you!