Almost 3 months after surgery and one nipple is still a little puffy

[skaterzin]

Hello everybody,

I was the author os this post:

https://www.gynecomastia.org/smf/index.php?topic=23198.0

Here are some brand new pics:







These 2 pictures show better the puffiness:




Well, in your opinion, should I do a revision surgery?

[skaterzin]

no one?

[Litlriki]

The asymmetry is apparent in the two extra photos.  And it may be possible that you'll require revision.  But at 3 months, my recommendation would be continued observation, and before considering a revision, consider a cortisone injection. 

Rick Silverman

[skaterzin]

Dr. Rick Silverman,

I can feel the gland in the puffy nipple.

Last time I went to my doctor, he said that it was perfect and that there was no gland left...

Anyway, how long should I wait to try a revision surgery?

thanks

[Litlriki]

As I said, I'd try a Kenalog injection first.  Your surgeon probably feels confident that he excised the gland adequately.  If that's the case, and one side is more swollen than the other (which we can see), it may be due to scar tissue rather than persistent gland, in which case an injection may reduce the tissue and help you to avoid surgery.  I usually hold off for about six months to do the injection, but on occasion, I will do it sooner if it seems obvious that scar tissue is causing fullness. 

RS

[Dr. Elliot Jacobs]

Totally agree with Dr. Silverman.

The key question is whether your surgeon achieved a smooth, flat contour at the time of surgery and if you were initially smooth and flat.  If so, then it is likely that the surgery was performed correctly.

Then, if one (or both sides) beging to protrude again, this is most likely the growth of scar tissue (not a re-growth of gland) -- and the best treatment would be a kenalog, or other type of cortisone, injection.  This is far, far better than additional surgery, which could also result in the growth of scar tissue months afterwards.

I, too, wait about six months before injecting cortisone, which is a powerful medication.  I much prefer to have the patient massage as much as possible.  And on occasion, I can inject cortisone earlier than six months.

Dr Jacobs

[DrBermant]

Hello everybody,

I was the author os this post:

https://www.gynecomastia.org/smf/index.php?topic=23198.0

Here are some brand new pics:

Pics from chest (1 month):

Well, in your opinion, should I do a revision surgery?

You have made it difficult to follow the progress. By starting a new thread, the pictures are in two different posts. In addition, your framing of the images is different. This is a common issue in evaluating a before and after surgery or progression of results picture set. I have only taken 2 of the images to demonstrate this point. In the other thread I answered:

Hello, my name is Diego and I am from Brazil.

I had gynecomastia surgery + lipo a month ago (I only had puffy nipples).

My left nipple, which was the bigger one, is a lot less puffy than before. However, the right nipple, which was not as puffy as the left one, is still puffy.

My doctor said the results were great, and that the nipples were normal.

But, for me, the right one is still puffy.
Today I told him what could we do if the right nipple remained puffy.

He said: Don´t think about it, there´s nothing more there. If we take anything out , a crater deformaty may occur.

Should I worry about it?

Its been only 1 month, but I´m kinda affraid that I may need a revision.

Looks like another Puffy Nipple Complication after gynecomastia surgery. A Crater Deformity is a phrase I coined after seeing horrible holes in chests after bad gynecomastia surgery done elsewhere. I also coined the Puffy Nipple Complication after seeing so many unhappy patients coming to me with residual tissues left behind by other surgeons. With both problems, I posted a number of examples, diagrammed mechanisms of the problem, and then showed surgical solutions. In a recent review of unhappy patients asking for help after surgery done elsewhere, there were more than 500 requests over a few years of cases reviewed. So many that it has been difficult trying to incorporate a series of additional web pages to show a representative collection of the issues and concerns.

No you do not need to leave such deforming tissues behind to not get a crater. I have many such examples on my site where I targeted the gland and have yet to have a crater from my techniques. That remaining tissue can often be removed and dealt with as long as the surrounding resources have not been depleted. I also added an example of a crater defect I did have enough tissues to revise until that patient saw a closer doctor for convenience who then removed those resources leaving an animation deformity that you should really see the movie to see just how bad a result can look.

At one month, the deformity is most likely residual tissue but it could be still swelling. Some surgeons' methods leave so much swelling that it can take months to resolve. That is why I wait a minimum of about 6 months before I offer revision surgery. This brings up a critical point, it is not just how the before and after surgery pictures look, it is also the path the tissue needs to take to get there. Looking for what any one particular surgeon's methods are like in that process can be quite revealing. The more destructive and damaging a method is, the more swelling and bruising.

I personally do not like such swelling and prefer techniques that have peak swelling on the operating table. I do not finish a case until I have a contour that I like.  The progression of swelling  and bruising seen on my website is typical for my patients. Over the years with critical documentation of the progression of my patients' tissues, I evolved my techniques such that peak swelling occurs on the operating table. I just do not see such swelling issues for my sculpture of my typical patient.

Check out my Standard Pictures for After Gynecomastia and even better Standard Videos for Male chest to better document the issues present now to better be able to document their current state and see what happens over time. If they evolve over time and improve, you have a surgical technique causing that much swelling. If they remain stable over time, there is the Residual Puffy Nipple Deformity. Be careful of selecting a surgeon for such revision. Revision surgery is an art form and looking for animation results is the best way to judge just what a doctor's methods are like.

Hope this helps,

Michael Bermant, M.D.

This is the power behind my Standard Pictures and Video set for documenting just what is going on, the problem, and solution. Match the new documentation to the framing of what you had to better understand what is going on. For residual puffy nipples, the oblique views show that contour, but the complete set is a better starting point.  Forum posting can be difficult with that many pictures. That is why I evolved to my roll over demonstrations on my website to better organize the images. In this situation, I would group the different time views together, such as the time different views of the obliques if only one angle is going to be demonstrated.

Just how tissues evolve after surgery is really dependent on so many factors. Once such careful documentation is no longer changing, then you have better tools to determine timing of possible revision surgery or other methods of intervention.

Hope this helps,

Michael Bermant, M.D.

[skaterzin]

I will be going back to my doc on september and I will sugest him the kenalog injection.
After that I will be coming here again.

thx