Experiences with Gynecomastia Surgery While Taking Accutane

[GynoNoMore99]

If you don't want to read below, this is my question, TL/DR: Understanding previously stated general guidance to wait 6 months to have surgery after coming off Accutane, has anyone on this forum had specific experience getting surgery while taking Accutane? Or have any doctors performed surgery on someone taking Accutane, and if so could you please provide me your specific experiences with this (specifically related to scar healing)?

--------------------------------------------------------------------------------------------------------------------------

Hello, 

I made an account on this forum many years ago, and recently have finally decided to schedule for gyno surgery. 

I scheduled for gynecomastia surgery with a well-known gynecomastia surgeon expert (well know enough that was booked so far out that earliest date could schedule from end of April was mid-September, which is when my procedure is set for...). I have 'mild puffy nipples' in my own words and was diagnosed with zone 1 gyno with puffy nipples. 

Unrelated, at the end of May I was prescribed Accutane (80mg/day at 85kg body weight) by my dermatologist for nodular/cystic facial/back acne. During the conversation with dermatologist, the topic of surgery never came up and didn't think there was any reason to mention the scheduled gyno surgery. Since then, I have found references online saying that one MUST wait 6 months after coming off Accutane before doing ANY elective surgical procedure for fear of improper scar healing or formation of hypertrophic/keloid scarring. This obviously scared the heck out of me, so I called both my dermatologist and surgeon to ask them about this. 

My dermatologist said that there was in the past a hard rule to wait 6 months before doing any procedure, but that this guidance was likely very overly conservative and has been challenged recently, and that the overwhelming likelihood is there will be no difference in my surgical experience/scar healing due to Accutane. He could not recall a specific experience he had with a patient having a surgery while on Accutane, and said that there was not a great deal of research on this topic as not a large number of cases studied where folks get surgery while on Accutane. 

My surgeon said that there should be no problem whatsoever with having the surgery while on Accutane. Stated that would only be concerned if skin grafting were to be involved, which would not done in my case. Said he has only operated on those taking Accutane a few times, but on issues with scar healing in those cases. 

I searched this forum for 'Accutane' and found below linked threads where multiple doctors (Jacobs, Cruise, and Pope) all stated to follow guidance of waiting 6 months after finishing Accutane to have surgery. Could not find any example where someone had surgery while on Accutane. However these threads are 8 years old at the most recent. 

I have also found a number of articles/papers from the recent years linked below (the first of which is from the British journal of dermatology) that challenge the guidance that one must wait 6 months after finishing Accutane to have surgery. They seem to indicate there is not a great deal of data, but no hard clear-cut evidence linking poor surgical scar healing to Accutane usage. 

Incidentally, in the past 2 months on Accutane I suffered a few minor burns to my arms/wrists (burned myself cooking a couple times) that initially formed darkly colored scars (but seemingly not worse than what I've experienced in the past before taking Accutane) that are seemingly healing normally and are much lighter in color now then when first happened and are not keloid. 

All that said, my questions for this forum: Has anyone here had surgery while on Accutane that would be willing share their experiences, specifically related to scar healing? Do the doctors on this forum still hold strong to not performing surgery on a patient taking Accutane until they are 6 months off the drug? Have they ever operated on patients taking Accutane, and if so how many times and what were the results?

With all the above said, I really do NOT want to postpone the surgery (following 6 month guidance this would be postponed until next May...) for a number of reasons, but I would very much appreciate any anecdotal experiences that any forum members could provide on this topic. Currently I am strongly considering having the surgery, and perhaps ceasing the medication for several days prior to/after the procedure out of an abundance of caution. 

Threads on this forum talking about Accutane usage related to Gyno surgery, latest from 2013:
https://www.gynecomastia.org/forum/ask-a-doctor/38/accutane/27080/msg177730#msg177730
https://www.gynecomastia.org/forum/ask-a-doctor/38/accutane-waiting-time/20683/msg141679#msg141679
https://www.gynecomastia.org/forum/ask-a-doctor/38/gynecomastia-removal-surgery-and-accutane/18043/msg125139#msg125139
https://www.gynecomastia.org/forum/your-stories/2/hypertrophic-scarring-from-surgery-pic-inside/26170/msg171794#msg171794

Articles/papers challenging 6 month waiting period for having surgery after Accutane, latest from 2018: 
https://onlinelibrary.wiley.com/doi/pdf/10.1111/bjd.12761
https://www.aad.org/dw/dw-insights-and-inquiries/dermatologic-surgery/scarred-by-dogma-revising-recommendations-for-surgery-and-isotretinoin-use
https://www.mdedge.com/dermatology/article/142110/acne/isotretinoin-patients-need-not-postpone-skin-surgery
https://pubmed.ncbi.nlm.nih.gov/26686845/
https://www.practiceupdate.com/content/should-isotretinoin-be-stopped-prior-to-surgery/6867


Thanks again to this forum for all the information/support it has provided!