Can scar tissue be very soft?

[pinchy68]

Hello Doctors,
   Can a scar tissue under an areola feel very, very soft, just like fat/gland and be contributing to some puffiness? If the areola is flat for some time after surgery but then starts protruding is this likely due to scar tissue (even though there is nothing hard under the areolas)?

   On a slightly unrelated subject: If the contour of the deeper tissues is good and consistent (i.e. no crater), why do surgeons still seem to leave some tissue under the areola before re-attaching it (I mean the tissue directly attached to the areola, not the deeper tissues attached to the chest muscle/fascia/fat)? Is it to retain the areola shape structure?
   Is it easy to differentiate in surgery the areola muscle from the other tissues and remove all the tissues under it without injuring the areola muscle, or is this something very difficult and that is why some tissue is usually left behind?

  Thank you,
     D

[Dr. Elliot Jacobs]

Yes, scar tissue can be firm or soft or in between.  If the areola is flat after surgery and then begins to protrude, it is most likely scar tissue rather than re-growth of breast tissue.

Every surgeon has his own methods and preferences in performing gyne surgery.  What counts is the final result.

BTW, please allow me to correct a misconception.  There is no muscle under the areola. There are tiny muscle fibers contained within the pigmented skin of the areola itself.  It is these muscle fibers which contract in the cold or during excitement and which make the areolar diameter slightly smaller and create tiny ridges on the areola itself.

Dr Jacobs

[pinchy68]

Hello Dr. Jacobs,
   Thank you for your answer.
   

BTW, please allow me to correct a misconception.  There is no muscle under the areola.  There are tiny muscle fibers contained within  the pigmented skin of the areola itself.  It is these muscle fibers which contract in the cold or during excitement and which make the areolar diameter slightly smaller and create tiny ridges on the areola itself.

   I want to confirm my understanding of your answer. Do you mean that the areola muscle fibers are contained right within the areola skin layer, and not deeper under the skin? So they are unlikely to get injured during a surgery?
   If I have areola deformity (when contracted) after my surgery (which wasn't previously there) can it be because of uneven scar tissue under the areola?
   Any idea why the areolas would protrude more after the surgery when cold than before? What is pushing the nipple/areola now out when cold/contracted? Or is there something that held the nipple/areola "down" before the surgery (it still contracted just did not protrude)? I read about Cooper's ligaments. Are those relevant in males?
   One more question (sorry about so many questions):
   3 years ago I had medication induced mild gyno. One effect was increase in number and prominence of Montgomery glands on my areolas (for a while I incorrectly thought that the small whitish bumps in my areola are milk ducts, but as far as I understand it now I was wrong). Have you heard about this before? Is there any way to reduce these? There is one area on one of my areolas where it seemed to have been cut thinner, and in that area the Montgomery glands disappeared (I'm speculating that the cutting destroyed their deeper structure).

   I very much appreciate your answer.
   Thank you,
   D

[DrBermant]

Hello Doctors,
   Can a scar tissue under an areola feel very, very soft, just like fat/gland and be contributing to some puffiness? If the areola is flat for some time after surgery but then starts protruding is this likely due to scar tissue (even though there is nothing hard under the areolas)?

   On a slightly unrelated subject: If the contour of the deeper tissues is good and consistent (i.e. no crater), why do surgeons still seem to leave some tissue under the areola before re-attaching it (I mean the tissue directly attached to the areola, not the deeper tissues attached to the chest muscle/fascia/fat)? Is it to retain the areola shape structure?
   Is it easy to differentiate in surgery the areola muscle from the other tissues and remove all the tissues under it without injuring the areola muscle, or is this something very difficult and that is why some tissue is usually left behind?

  Thank you,
     D

Scar tissue like gland or fat can be firm or soft. You have cuts from before, each such injury heals with a scar. How well that scar evolves depends on the injury, how / if it was repaired, Scar Care, Compression Therapy and other factors.

Puffy Nipple Complication After Gynecomastia Surgery can consist of residual gland, scar tissue, loose skin, and other factors. Feeling the tissue alone does not differentiate what the nature of this tissue is. The main factor is if there is a contour defect. This contour can be from fat, gland, or scar tissue. Check this link out and see what I mean. Without support, the nipple areola tissues attach to the muscle producing a Crater Deformity when the skin is adherent to the deeper tissues or a Bursa Crater Defect when this skin is free floating over a defect of supporting tissues.

The normal chest should look good both at rest and during animation. Fat is our body's lubrication layer permitting the skin to move naturally. Firm scar tissue or gland does not move or compress like the surrounding fatty tissues. That is why targeting the gland first is the hallmark of my Dynamic Technique, I want to have results that look good from all angles and during animation. Be cautious with doctors that demonstrate their results with just in a few photographs using selected angles that seem to change from one patient to the next.

The Thin Under Skin Areola Muscle is diffuse extending from the skin itself to surrounding structures. It looks very much like connective tissue and dermis and comes in various degrees of development in different patients. Some of my patients actually have a well enough defined muscle layer here that I repair it during my surgical sculpture as a separate layer.

Hope this helps,

Michael Bermant, MD
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