5 days post-op and I'm worried that I've been ripped off

[derek19852013]

I was diagnosed with grade 1 gynecomastia or pseudogynecomastia, with abnormal fatty deposits on my chest. Thankfully there was no glandular tissue to be excised. Last Saturday I had laser liposuction and have been wearing a chest garment and taking painkillers since. I am to meet my Dr 7 days after the operation but I am not happy with my results so far. My pics are below:

This is pre-op me. As you can see, I have puffy nipples, a white ring behind the areola and and my chest sags.



This is my one-day post-op. Everything seems fixed.


A day later, this is me. Same puffy nipples, same white ring around the areola and just like before, any polo shirts I wear hang on my chest area. It's like I haven't had anything done bar removing some fat around the top of my chest.


Have I been ripped off or is the puffy/white ring area swollen and thus, appears bigger? I'm well aware that it's very early to judge but it just seems like perhaps I was misdiagnosed because the same problem persists. Having spent a lot of money, I hope I haven't wasted it. The expertise of the doctors would be much obliged.

[Dr. Elliot Jacobs]

It is much, much too early to try to assess the results of your operation.  Swelling actually increases over the first few days to a week after surgery before it begins -- slowly -- to decrease.  Therefore, you should just be patient.

It does not appear that you have a peri-areolar incision, so you should inquire of your surgeon if he removed any solid breast tissue through the external incision.  Most often, puffy nipples require gland excision as well.

I am not a fan of Laser Lipo ("Smart Lipo") since it truly does not remove or vaporize breast tissue at all.  It is a relatively new technique which has been hyped in the lay media but has not gained any real acceptance amongst doctors who actually do lipo or gyne surgery.  In essence, it is, IMHO, a marketing gimmick.  One of the "selling" points is that it can be done while the patient is awake -- which is supposed to take away some of the fear of anesthesia.  However, since the patient does not have enough anesthesia, it can be very painful or the surgeon may stop prematurely because of the pain inflicted and therefore render an incomplete operation.

Dr Jacobs

[derek19852013]

Hi Dr Jacobs,

Thanks for your reply. After my initial consultation I asked for the diagnosis in email and was told that I had " abnormal fat deposition in your breast without any glandular hypertrophy (grade 1 gynaecomastia)", which would indicate that the surgeon saw no need to make that incision. Hence I'm worrying if I was misdiagnosed. I will be speaking to him on Saturday for a one-week update. I'm aware that the results right now are skewed by the swelling but it's the nipples and specifically the white ring around the areola that has me a little worried.

[Litlriki]

As already stated, it's too early to really comment on your result, since swelling increases over the first post-operative week.  I think it's nearly impossible to know beforehand if there is or isn't glandular tissue, therefore, I always prepare my patients for the peri-areolar scar, and if I don't need to make it, which is rare, so be it.  Many of the regular surgeons who address this forum take a similar approach.  The "occasional" gynecomastia surgeon is more likely to try and avoid the peri-areolar incision, since he or she may have greater concern over managing the glandular tissue or creating a crater, etc.  If liposuction alone was not adequate, your surgeon can always go back and excise glandular tissue.  At this point, however, you need to wait!

Rick Silverman

[derek19852013]

3 week update (pics below). I'm meeting with my surgeon this week and things haven't improved much at all. Still wearing compression vest 24/7 and chest area still somewhat tender but the results don't seem to be coming.

As you can see below there is a lot of puffiness still present. To be honest, these do not look like 'post-op' pictures at all and whenever I have tried on any t-shirts/polo shirts etc they hang around the chest area, just as they did before the operation. I'm trying to be patient but surely things should better than this after 3 weeks? Thanks.

[Dr. Elliot Jacobs]

At 3 weeks, you are just at the beginning of a long healing process.  There is always swelling after surgery - sometimes prolonged swelling, and oftentimes asymmetric as well.  Wear your compression
garment as snug as possible for as much as possible.  The tenderness and firmness is absolutely normal at this time.

If indeed any revision might be indicated, it should not considered until much of the healing has occurred -- usually six months or even much more.

Keep an open mind and consult with your surgeon.

Dr Jacobs

[Litlriki]

I agree with Dr. Jacobs. You may require a touch-up, but that's not definite at this stage, since it's very early and you still have swelling at the site.  I won't entertain the secondary procedures before six months, and generally, I prefer waiting 9 to 12 months.  Patience!

RS

[DrPensler]

While its early in your recovery the overwhelming majority of my patients require excision combined with liposuction.Isolated liposuction regardless of the type rarely yields a satisfactory result. I would also suggested that based on your body type it is unlikely that " there was no glandular tissue to be excised ". In any case at this point you need to let the swelling subside.

[George Pope, M.D.]

In spite of my best efforts to educate patients preop about the healing process,  I occasionally have patients who are concerned within the first week after surgery because they don't like their result.  As has been stated by several docs on this thread, one week after surgery is WAY too early to form an opinion about a surgical result.  That's when soft tissue swelling is at its max.  I agree with Dr. Silverman that it's best to wait at least 6 months before considering revision surgery. If scar tissue starts to build up during that period I may consider steroid injection.

Keep the group posted with updated photos.  In your particular case, tissue excision might be warranted down the road.

Dr. Pope, MD