Understanding Glandular Tissue

[Coffee]

I had Gynecomastia surgery with Dr. Baxt in October of last year. I am not happy with the results. He stated he could remove breast tissue and fat with his microexcisional tool but it doesnt seem like he had much success (or he was deceived by the way my chest looked while I was on my back in a cold operating room). He thinks it looks good but I can still feel some rubbery like tissue behind the nipple. There is still some puffiness especially when Im warm (only when my arms are down). It feels like hard raisins but its not directly behind the nipple. Can the glandular tissue proliferate towards the upper part of the chest and all over? I dont know where the gland tissue truly starts or ends. Also, is the male chest just more fibrous then other parts of the body and could that be it. Any advice would be helpful. Im thinking about getting a mammogram done to determine what is what. Any advice would be great. Thx

[don_joe]

Dude, you're about only 6 months in.

What you feel might very well be scar tissue...

[TXdude]

I had Gynecomastia surgery with Dr. Baxt in October of last year. I am not happy with the results. He stated he could remove breast tissue and fat with his microexcisional tool but it doesnt seem like he had much success (or he was deceived by the way my chest looked while I was on my back in a cold operating room). He thinks it looks good but I can still feel some rubbery like tissue behind the nipple. There is still some puffiness especially when Im warm (only when my arms are down). It feels like hard raisins but its not directly behind the nipple. Can the glandular tissue proliferate towards the upper part of the chest and all over? I dont know where the gland tissue truly starts or ends. Also, is the male chest just more fibrous then other parts of the body and could that be it. Any advice would be helpful. Im thinking about getting a mammogram done to determine what is what. Any advice would be great. Thx

I am having the same exact thing. I had gyne surgery alost two months ago and there are two nubs of hard tissue under each nipple. I think it's the fibrous gland tissue. When I slide my hand down my chest they are obvious to touch. They aren't visually that obvious, but I'm concerned about what they are, what I should do, and will they go away?

[Dr. Elliot Jacobs]

The body heals with scar tissue after surgery -- this is Mother Nature's handiwork.

What is important is that your contours look smooth and even.  No-one (other than you) is going to pinch your nipples and check whether you have a small lump underneath. 

I find many patients are concerned about this -- unnecessarily.  Whether it is scar tissue or a small amount of gland which was deliberately left by the surgeon to support the areola, what counts is the contour!

Yes, one can treat scar tissue with kenalog -- but in a result with good contours, kenalog might create a crater problem where none existed.  Or, if you insisted on having surgery to remove the firm tissue, it could create a crater.  Or, you might heal with -- you guessed it -- more scar tissue.

Please accept some wisdom gleaned from many years of experience:  Sometimes it is better to accept a 99% result than try for a 100% and end up with a 90%.

Dr Jacobs

[DrBermant]

I had Gynecomastia surgery with Dr. Baxt in October of last year. I am not happy with the results. He stated he could remove breast tissue and fat with his microexcisional tool but it doesnt seem like he had much success (or he was deceived by the way my chest looked while I was on my back in a cold operating room). He thinks it looks good but I can still feel some rubbery like tissue behind the nipple. There is still some puffiness especially when Im warm (only when my arms are down). It feels like hard raisins but its not directly behind the nipple. Can the glandular tissue proliferate towards the upper part of the chest and all over? I dont know where the gland tissue truly starts or ends. Also, is the male chest just more fibrous then other parts of the body and could that be it. Any advice would be helpful. Im thinking about getting a mammogram done to determine what is what. Any advice would be great. Thx

The Normal Anatomy of Puffy Nipple Gynecomastia can be distorted by surgery. Gland / scar tissue can extend in unusual ways beyond the areola. I have seen many bizarre configurations with the many revisions I have done for patients unhappy after other doctors' surgery.  Male Mammorgrams will not differentiate between scar and gland.

The question is there a contour deformity or just firm tissue. Firm tissue that does not show up on animation, may be a reasonable result. Firm tissue that puffs out with relaxed skin areola muscles or with chest muscle flexing or activities might warrant revision. Posting Standard After Gynecomastia Surgery Pictures or Standard After Gynecomastia Movies can help others better understand your concerns. A good result should look more than just good from a front and side view. It should look good with arms up, flexing muscles, and while at play. It should also look good when the areola muscles relax in the heat.

I see many patients who complain of residual deformity of Puffy Nipple Gynecomastia after another doctor's surgery.  There are many possible problems causing such a deformity.  The most common is remaining gland behind the areola as seen in these Anatomy of Puffy Nipple Drawings.  Check out the images with the link for remaining gland after surgery to see what I mean.  

Here are just a few of the many examples I have seen and treated:

• Revision Gynecomastia After Failed Liposuction By Other Surgeon
• Revision Puffy Nipple Gynecomastia After Failed Liposuction By Other Surgeon
• Revision Gynecomastia After Liposuction and Partial Gland Excision By Other Surgeon.
• Revision Gynecomastia After Partial Gland Excision
  

Tissues need to heal before considering revision surgery, this can take from 6 months or longer depending on the injury created.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia Chest Sculpture