Excision of Gland Time-Lypo 6 Months Ago

[yet-another]

I had gynecomastia surgery about 6.5 months ago.  At that time, my surgeon said that he may or may not do the excision of the gland/tissue at that time.  It basically would be determined during the surgery.  He said that I had the option of coming back later after things had healed to see if it would be necessary. 

So on the day of the surgery, no tissue/gland was removed by direct excision.  Now 6.5 months post op, I can determine that I am going to need the removal of the gland as well on both sides.  This will be done under local anesthesia.  What kind of pain and recovery can I expect from the excision procedure only?  Will I need to wear my compression vest again?  Would I be able to return to work the next day (non physical)?

Thanks.

[DrBermant]

I had gynecomastia surgery about 6.5 months ago.  At that time, my surgeon said that he may or may not do the excision of the gland/tissue at that time.  It basically would be determined during the surgery.  He said that I had the option of coming back later after things had healed to see if it would be necessary. 

So on the day of the surgery, no tissue/gland was removed by direct excision.  Now 6.5 months post op, I can determine that I am going to need the removal of the gland as well on both sides.  This will be done under local anesthesia.  What kind of pain and recovery can I expect from the excision procedure only?  Will I need to wear my compression vest again?  Would I be able to return to work the next day (non physical)?

Thanks.

I see many patients unhappy with residual gland after Liposuction Only Gynecomastia Surgery done by other doctors.

Recovery After Gynecomastia Surgery depends on the current problem, what will be done, after surgery care, and many other factors best discussed with your surgeon.

Local anesthesia and "gland" excision alone are normally not sufficient for this dynamic contour problem. I prefer to target the residual gland and scar tissue first and often need my Fat Flap Reconstruction to contour patients I see for revision after other doctor's surgery.

For my patients, After Surgery Compression, both first and second stage are valuable tool to minimize scars, bruising, and swelling after gynecomastia surgery.  Pain and Discomfort After Gynecomastia Surgery is also surgeon / technique dependent and something you need to check with your own surgeon's results. Although I prescribe a strong pain medication, my patients typically tell me that plain Tylenol is enough to keep them comfortable.  My patient can return to light work the day after surgery.

All of these factors are why choice of surgeon can be so critical for this surgical sculpture.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

[Dr. Elliot Jacobs]

At six months post op, you are probably looking at close to the final result.  If both you and your surgeon agree that additional surgery should be done, then go for it!

When i have been faced with similar situations, I treat it as a primary case, using lipo instruments as well as gland excision -- although these secondary cases are always more difficult due to the inherent scar tissue that is present.  BTW, the lipo cannula need not necessarily be used with suction -- I sometimes use it without suction just to allow the skin to  distribute more uniformily after direct gland excision.  I absolutely use sedation anesthesia for these cases -- there would be too much discomfort associated with local anesthesia alone.  Also, the presence of scar tissue does not allow for even distribution of the local anesthetic.

Post operatively, I would treat the situation again as if it were a primary operation -- this includes restricted physical activities as well as a compression garment.

Good luck!

Dr Jacobs

[yet-another]

Well i'm getting the revision (gland/tissue excision) done tomorrow morning.  Hopefully all goes well.  I plan on wearing the compression garment again during healing.  How long do you think I need to wear the garment this time around?  For the lypo portion, I think I wore it about 6 weeks.

Thanks. 

[Dr. Elliot Jacobs]

Good luck with your surgery -- hope all goes well.

Would wear the compression garment as long as you wore it the first go around.

Let us know how things went.

Dr Jacobs

[yet-another]

Just had the revision surgery a couple of hours ago.  It was surprisingly relatively pain free.  It used local anesthesia only.  There were a few "weird" sensations a few times, but nothing I would describe as painful.  Even the lidocaine injections weren't that bad.  I was surprised at the large chunks of "grissle" like tissue removed.  The doctor said it was really tough.  I guess this is why exercise has no effect on it at all. 

So I guess I have to wait now and see how the final results come out.  I know it won't be perfect, but will be much better than before.  I'll be sure and post pictures when things have settled down a bit.  I even returned to work right after the procedure.  I'm sure that once the numbing medication wears off, i'll be in more pain, but right now it's not bad at all.  I will start wearing my compression vest as soon as I get home.  Man I hate that thing!   

Thanks for all the great advice. 

[yet-another]

About a week and a half post op of the excision portion, I noticed that the right side seemed very swollen compared to the left side that was relatively flat.  I felt the breast and to me it felt hard.  I decided anyway to poke a small hole about 1/2 inch above the nipple into the chest tissue. 

Man did the blood/yellow substance rush out.  I massaged the area for about 20 minutes to make sure that it had all come out.  I would estimate the total amount of fluid to be 1/4 cup if not more.  I repeated the same thing about 3 days later with the same result but much less fluid.

I know you guys probably hate hearing about patients that try to do anything on themselves, but I tried to be as sterile as possible.  I actually see my doctor today for a checkup, so i'll let him know what I did.

[Dr. Elliot Jacobs]

Sorry to tell you but that was the wrong thing to do.  As much as you might think, your "poking a hole" was probably not a sterile procedure and you run the risk of introducing infection underneath the skin.  Certainly, if you had gone to your doctor, he would have diagnosed the problem and then treated you by aspirating the fluid under proper sterile conditions.

Dr Jacobs

[DrBermant]

About a week and a half post op of the excision portion, I noticed that the right side seemed very swollen compared to the left side that was relatively flat.  I felt the breast and to me it felt hard.  I decided anyway to poke a small hole about 1/2 inch above the nipple into the chest tissue. 

Man did the blood/yellow substance rush out.  I massaged the area for about 20 minutes to make sure that it had all come out.  I would estimate the total amount of fluid to be 1/4 cup if not more.  I repeated the same thing about 3 days later with the same result but much less fluid.

I know you guys probably hate hearing about patients that try to do anything on themselves, but I tried to be as sterile as possible.  I actually see my doctor today for a checkup, so i'll let him know what I did.

Without permitting your doctor to help, you can really make a mess. If you end up with a horrible infection, loss of part of your chest wall, hospitalization, or worse are all issues you have brought upon yourself. If you get away with it, consider yourself lucky. Blindsiding your doctor, not keeping him / her aware of critical issues, taking over the care yourself unsupervised are never smart courses. Such actions are a formula for a disaster. I would never ask a patient to perform what you assumed was a good course, even if the patient was one of the many surgeons who have asked me to sculpt their bodies.  I would never perform self surgery on myself.

A doctor who has himself / herself as a patient has a fool for a doctor.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[yet-another]

I had a feeling that you guys were going to "scold" me and with good reason.  It's just so hard to resist the urge sometimes.  I tried as much as possible to be sterile.  The area doesn't show any signs of infection.  I had a follow up yesterday and the nurse didn't comment on any infection like appearance.  I did tell her that I had aspirated myself. 

Hopefully I got away with this one, but I agree that this type of thing is best left for the professionals.  In a couple weeks, i'll post pre and post op pictures.  I really wanted to wait until I had done both the lypo and excision portion.

I am still wearing my compression vest.  This Thursday will be three weeks.  How long should I continue wearing the vest?

Thanks as always.

[Dr. Elliot Jacobs]

How long to wear the vest?  In my practice, a minimum of 3-4 weeks is recommended.  And if you can stand to wear it longer by 2 or even 4 weeks, it can only help -- it cannot hurt.

Dr Jacobs