Unhappy :( Puffiness again, is this scar tissue or gland? 6months post op

[Adamasina]

First of all thank you guys for taking the time to read this, hopefully, you can help, i had a gynecomastia surgery 6 months ago (lipo +  incision in areola to remove the glands)
I'm not happy with my results although my surgent say it's "Satisfying results" i'm talking to him but he doesn't seem to understand the hell we (guys who have this issue) went thru, (avoiding the beach, certain clothes, sports, low self-esteem..) i only did the surgery because i wanted to put this behind me, no more puffy nipples, i wanted a flat chest.
I had a flat chest for like 55 days months after the surgery, i had the vest day and night for 4 weeks, and only the day for 2 weeks so 42 days  (it was smooth, no complications, all good, even the scars are barely noticeable)

I'm not sure if it's accidental or meant to be, but i started having a big puffiness after I massaged the left side in a hard way as i read online to break a bit the scar tissue, now i'm not sure, maybe the surgent left more of the gland in one side, he said he didn't but he left a few because it's necessary, please guys, with all these photos, and in your experience what could this be? Gland or scar tissue, i'll describe the feeling, i definitely have something bumpy in the left of the nipple when i use the roller.

[Dr. Elliot Jacobs]

You obviously have residual puffiness and what appears to be some residual excess tissue as well.  What is causing the puffiness?  It may be residual gland that was retained by the surgeon to prevent a crater deformity -- or scar tissue which formed after surgery -- or most likely a combination of both.

After many thousands of gynecomastia operations, I have come to realize that puffiness is due 100% to excess gland directly under the areola.  True, when the nipple is stimulated or is exposed to cold temps, it may look temporarily better (due to some tightening of the areolar skin which pushes the breast tissue down) but then it reverts to the puffiness once again.  The only way to deal with puffiness is to completely remove the gland under the areola and replace it with fat in the form of fat flaps.  At the completion of surgery, the areolar diameter has diminished in size and the areola lies flat and flush with the surrounding skin -- all the time!

If your original surgeon is unwilling to revise your surgery, then consider seeking help elsewhere.

Good luck!

Dr Jacobs

[Adamasina]

Thank you for your response, i find it weird to be flat for 2 months, then bad puffiness like i did not the surgery (of course big difference because most of the gland is out, but still..) 

Anyway, unfortunately, i don't have money to even travel to that city where i did the surgery..

[Dr. Elliot Jacobs]

Your description is not unusual.  Sometimes there is still some gland retained by the surgeon but there is also surrounding swelling -- so the skin look flat with no puffiness.  As the swelling subsides, the areola may then exhibit some puffiness.

Another scenario is that all was done correctly at surgery -- but then you developed some puffiness due to scar tissue directly under the areola, which takes a few months to grow.

Truly, only the surgeon know exactly what was done during the surgery and only he can provide a definitive answer for you.  If it is only scar tissue providing puffiness, then some cortisone injections might be helpful.

Dr Jacobs  

[Adamasina]

Thank you doc, you are way better of my surgent, at least in talking to me, unfortunately, he pissed me off with his way of talking, he doesn't know, or understand what a guy with this issue has faced in life (or avoid to do because of this issue), he told me it's perfect, it's a satisfying result, how can you say that if the goal was to have a normal chest at least wearing a tight t short like i always hoped before the surgery.

He told me he wouldn't take all of the gland, which is i know, but i think, he left more than he should in the left side, the right side is fine.

Doc if i may ask, is there anything i can do to make this better? I read online that "CICA CARE Silicone Patch" can soften the scar tissue (although i'm not sure this is scar tissue because i feel something bigger), is this true?

PS: My surgent never did steroids shots or anything like that, so it's not an option here.

[Dr. Elliot Jacobs]

If indeed your problem is scar tissue, it is inside and cannot be treated by external application of silicone strips/patches on the outside.  It would have to be treated with a cortisone injection.   Sorry

Dr Jacobs

[Dr. Schuster]

I agree that your results cold be better. This residual central puffiness is usually due to gland or scar tissue, though rarely you could have a chronic seroma. An exam would be helpful. Nevertheless you will probably need revision with an open approach. If it is just scar tissue you can try a steroid injection. A seroma can be identified with a simple aspiration attempt.