Gland excised in 2008 - seeking Lipo in 2012 *Need Advice

[siphon]

Before I proceed, I'd like to thank all of the doctors who contribute to this site! your experience and pointers have helped so many of us



I had glands excised in 2008 which was covered by a surgeon in Alberta by AHC, who was not a fan of compression of any kind throughout recovery/healing process. Big mistake after reading more on these boards. Also, he does not specialize in this surgery or liposuction (hand reconstructive surgeon) in general, but he was very confident that he could do it.

The initial results were great, but since then and without the much needed compression, scar tissue has developed and what both the surgeon and myself feel is gland regrowth. (hormone levels came out within normal range, no PH use, or excessive alcohol/drug use during this time)

In the span of the last few years, the scar tissue/gland would get to the point of being quite dense and would protrude from my nipples, and his solution was to inject cortisone into both sides every 5-6 months. This solved the dense/hardness temporarily, but there was still the issue of a handful of fat on both sides. (30 yrs old, 5'9, 180 lbs currently and healthy overall)

Fast forward to now.  The last injection I had was 5 months ago, can not feel my glands or scar tissue at the moment, but there is still an excessive amount of fat in the area. I've consulted with another surgeon who is much more experienced in this area and specializes in plastic cosmetic surgery, and after thorough research i definitely feel confident in his abilities.

He will be doing liposuction, but will excise if he feels more gland.

My question to the doctors or anyone else who has read this far...should the doctor focus on cutting out internal scar tissue while i'm under? what if he decides not to excise gland, but they reappear 6-8 months down the road? currently feels hollow behind my nipples, so the only thing making them protrude is breast fat at this point.

Also, do the nipple generally shrink after fat is taken out behind them?


Ciff Notes:

-Had surgery 4 years ago, gland excision only
-Scar tissue growth, minimal compression, possible gland regrowth
-Considering lipo, but should I ask for lipo and gland now just to be safe?

Thank you all!!

[Litlriki]

Having already had gland excision, it's tough to know if you'll require further excision.  But as long as your surgeon is prepared to do that as well as the liposuction, then you will have to trust his intra-operative judgement .  I re-excise in the case of most of my revision, but not always.  After the liposuction is done, he should be able to feel if there's excess gland or scar tissue, and he can do the excision if needed.

Rick Silverman

[DrPensler]

It would be useful to see some photos. Without any knowledge of the exact type and extent of the dissection with no photos makes it impossible to comment in a meaningful way.

[siphon]

Thanks for your thoughts!

I've uploaded some photos. the picture was taken in January 2012 before receiving cortisone shots on both sides, which my current doctor opposes. the hardness is gone, but still puffy and protrudes. My pre-op pics look much better than the one below, which is the worst picture i have so you have an idea of what i'm dealing with.

surgery is scheduled for July 13 and im both nervous and excited about the outcome.

generally, is it any more or less difficult of a surgery if its a revision? specifically re-removing the gland if its grown back?

[Dr. Elliot Jacobs]

In my experience, most apparent re-growth of tissue is indeed scar tissue.  When caught at an early stage, treatment of the scar tissue with cortisone can be helpful in eliminating the need for additional surgery.  When a large amount of scar tissue has formed, then unfortunately secondary surgery may be needed.

Secondary, or revision, surgery is always more difficult and less predictable because there is now scar tissue present, as well as any residual fat and gland.  However, in the hands of an experienced surgeon, you should emerge with a good result.  Further, I would strongly advise firm compression after surgery and then careful monitoring for any signs of possible re-appearance of scar tissue.  Should that be the case, then cortisone, in sufficiently high doses, may be necessary to keep it in check.

Good luck!

Dr Jacobs

[siphon]

Thanks for your response Dr Jacobs. I'm wary of having too much cortisone injected because I'm not sure how it affects the body years down the line. Tissue sinking, discoloration, concavities etc. What's your experience or thoughts on patients who are administered cortisone over long periods of time (years)?

But agreed, I will be applying strong compression for the weeks/months following surgery this time around. My surgeon recommends 12 weeks of continuous compression, does this seem excessive or is it merely a precautionary measure?

[Dr. Elliot Jacobs]

There is no right or wrong as regards post op compression.  I usually recommend at least one month or even 6 weeks -- I doubt if it would be beneficial after that.

As for cortisone injections, in my practice, rarely is more than two treatments with cortisone necessary -- it should not go on for years.  If it is injected properly and in sufficient dose, then that's all that should be necessary in most cases.  There are no long term side effects in these cases.

Dr Jacobs

[siphon]

Thanks again Dr Jacobs.

I do have another question. If my surgeon decides to do only lipo, will that help in reducing the size of my areola? My initial surgery was excision years ago and since then my nipple size is the exact same, but i'm wondering if its being pushed out because of the excess tissue behind it?

I did notice when I first had the surgery, my nipples were quite small for a month or so, and they've also been relatively smaller when i lose fat all over my body, even if by only a fraction of the size.

Dr Jacobs and Dr. Silverman, what are your thoughts on areola shrinkage with solely gland removal, solely lipo, and a combination of the two?

Obviously from my picture my nipples are still rather large. Is nipple reduction something i should ask about? or would merely removing what seems to be pushing them out (tissue/fat) solve the problem?

Thanks again to both of you!

[Litlriki]

Generally, the areola shrinks significantly after proper removal of the gynecomastia tissue, whether that's by liposuction, excision or a combination of the two.  It's been my experience that gynecomastia with puffy nipples requires some gland excision in addition to liposuction.  However, I have seen patients with larger areolae (not necessarily "puffy") get some shrinking even after just liposuction. 

I would not recommend areolar reduction until you've had proper removal of the gynecomastia, since this will add scar and increase risk of the procedure.  And based on your photos, I would think that you'd get adequate shrinkage. 

RS

[Dr. Elliot Jacobs]

When the areolas are large, I find that shrinkage will always occur.  It is helpful to undermine surrounding skin during surgery.  This can be done with lipo or with excision.

I echo Dr. Silverman -- I would be reluctant to do direct areolar reduction.  The resultant scarring is not very good.

Dr Jacobs

[DrPensler]

You have tissue that is present behind the areola region on both sides. The correction would require excision. I cannot comment on if this is recurrence of glandular tissue, insufficient initial resection,excess scar or new fat. Glandular tissue and scar are fairly firm.in any case there is tissue there which would benefit from removal.Good luck!

[siphon]

Thank you Dr's Silverman and Jacobs for your insights on areola reduction surgery. I will definitely heed your advice!! I'll be sure to post proper before/progress/after pics as well to keep everyone informed.

Dr. Pensler, I agree there is something still behind my areola pushing them out. This picture was taken immediately before cortisone injections 5 or so months ago, however contour in this time has changed minimally (possibly due to overall bodyfat gain). At the moment, the firm tissue is gone and I feel a hollowness right behind my nipples yet they still protrude. When I am cold and my skin is taught, no gland or tissue can be seen or felt..at the moment anyways.

I have confidence my surgeon will make the correct judgment call during surgery (I hope!), would be great to get this sorted out in one session! But in the mean time I'm doing the best on my side; reducing bodyfat all over, eating healthier, adding a bit more muscle to my frame, and no alcohol or inhalation of noxious fumes.

Again, thank you all for your expert advice during these insecure times.