How to reduce/avoid hard lumps or scar areas soon after gynecomastia surgery

[Geoff88]

Ok so I have certainly seen numerous posts on this and other forums where people have posted the same question that I had "I'm 5 days / 2 weeks / 6 weeks (etc) post op and I have these hard lumps or areas, what are they and will they go away??".  I wanted to return to the forum and contribute my solution to the lumps which many say could be scar tissue.  I think if you treat it when you discover them, or when you read this, I hope it should also help you the same way it did me.

What lumps / hard areas?
Just to be very clear, I'm referring to hard tissue or balls behind the nipple or elsewhere around your surgery area which may be tender to touch, it normally raises the anxiety of posters here and elsewhere, naturally.

Some people think the surgeon forgot to remove some gland, scars, return of gland, etc. but in my case, and I'd be certain in many cases, it is really just fluid and swelling (yes hard lumps or large flat areas) due to the trauma of the surgery and swelling.  Doing as many do, I read lots of opinions and I found that the general view of surgeons is that a) it is simply too early to panic, b) it will dissipate, and c) keep your compression fittings on and wait.

In my case I had a large area on the right which was about a 1/4 the size of my palm plus a smaller area on the left, and after just 10 days there's no way I could say it was scar tissue.  It's also the same for those people where it appears after longer periods of time.  Mine appeared soon after removing the compression bandages, and hence I thought that the compression top I had may not be snug enough to provide sufficient compression as required.

To test my thoughts, I reapplied the bandages first light to medium and then readjusted after around 12 hours (tighter) and guess what - the lumps dissipated.  Compression really is the key to reducing swelling and it will improve your healing, and I can't see that in my case the top alone would be enough compression.

This week I tried a suggestion I read elsewhere, which was to apply a back support or ab bind to the chest area instead of having my wife wrap me up whenever the bandage needed adjusting.  I'd basically recommend that you find something that works for you, but find a way to properly compress the area and wear it full time for as long as possible (4 weeks?) and then part time for as much as 8-12 weeks.

What is recommended:
Compression, compression and time seem to be the main requirements - and ask your doc if you're unsure.  Otherwise, yes the lumps are normal, but can be managed away with good enough COMPRESSION (get the hint?!).  In my case massage after 10 days was not recommended, and should probably only be done after "at least" 2 weeks and more probably 3-4 weeks - it was too tender and I felt that any massage would potentially be disturbing the healing process within the chest tissues.

Points to pay attention to:
- Apply good even pressure to affected surgical areas.
- Ensure pressure is sufficient, it should be quite firm.
- Check pressure is not excessive, it should not impede breathing or be too uncomfortable/reduce blood flow to tissues in the area.
- Check for softer results in 1, 2 and 4 days.
- Monitor with the support of your surgeon.
- Do not feel your chest too often during the first few weeks.
- Don't massage too early in the healing process, and when you do massage, use good even pressure with your palm which is not too aggressive.

If necessary print information available here on the forums to show your doctor as there is ample information to support the requirement for good compression in order to aid recovery for many patients.  It may simply be that your surgeon has not had many cases requiring a different approach to compression or recovery.

The earlier you support recovery with "sufficient" compression, the better your chances are of eliminating hard areas and avoiding ongoing adverse results, the better your chances are of getting a good visual result.  Just remember a compression vest may not be enough.

If you have actually developed scar tissue inside, then it can be treated with injections later (Kenalog or an alternative corticosteroid), so don't lose hope even if that happens.  Injections can't help reduce gland prior to surgery but they certainly do help with scar tissue.   However if you apply enough compression, and follow your docs advice otherwise, any hardness will disappear.  Note also, that many people have a lot of success from massaging a few weeks after surgery, and their hard areas eventually disappeared with that treatment alone - however just to be blunt about it, I'm suggesting that compression is what assists to avoid or reduce the need for that.

Please feel free to post your experiences, especially if this has also worked for you!  Your contributions are very important to people that will visit these sites after you.  Surgeons, please contribute thoughts as well.  Cheers and all the best for your recovery!

[Turbotime15]

Hey just had my surgery done on the 16 of Feb by Dr lebowitz In long Island. Only gland removal. I went two days later for draining and post op visit, then again the following Saturday because I felt something weird which happened to be fluid, so he drained both sides a bunch. And then I went one last time the following Saturday to get some more drainage done. I still feel a firm almost rubbery balloon type mass on both sides maybe my right a little more then my left. Do you think I should go for one more drain visit? Too much drainage? Very happy with my nipples though lol=)  thank you for your post and tips

[Geoff88]

Mobile fluid could be a different kettle of fish, but you describe it as "rubbery".  What you seem to describe is a seroma which is discussed In ample places on this and other forums (reddish or orange low viscous liquid) which is collecting within a pocket of tissue.  Is that what your surgeon has called it?

Seromas need draining, as you've had, and it isn't quite the same as hard lumps as experienced by others and described above.  But having said that, again you'll read that compression is very important to avoid or reduce your chances of getting them, and scare tissue developing as a result.

Can you describe what bandages you had after surgery, and what compression top you are wearing now (or other compression?) and how firm it is etc?  In your case I would think compression is even more important, just visualize how separated the tissues must be in those pockets - there is (again according to other docs on these forums) a need to keep draining, and make sure your compression is adequate.

I'd definitely go again to do drainage, and then immediately apply a lot of pressure.  You have a very experienced doc so he should be able to give you a lot of advice.  I have found some docs are far more low-key on seromas so as to not make a fuss or raise your anxiety (my doc is very serious and very experienced and does around 3-5 gyn surgeries a day plus a lot of other plastic surgery - dr lebowitz seems pretty personable, "thumbs up"!), and they aren't that big a deal in the end, but I'd be chasing very good compression if I were you in order to get that rubbery area very soft and the tissues all together so as to maximize the chances or an excellent healing result.  I'd use Ace bandages to keep it nicely flat with good pressure, is that what you are doing?

Your surgeon is going to know best because he will know how much gland was removed, your gland was minimal.  It seems seromas and swelling/lumps are more probable after larger gland removal.  It would be interesting however to hear what bandages you currently have, or top etc (how very firm it is) you are wearing?  It will also be quite important in your case I'd expect.

[Turbotime15]

Mobile fluid could be a different kettle of fish, but you describe it as "rubbery".  What you seem to describe is a seroma which is discussed In ample places on this and other forums (reddish or orange low viscous liquid) which is collecting within a pocked of tissue.  Is that what your surgeon has called it?

Seromas need draining, as you've had, and it isn't quite the same as hard lumps as experienced by others and described above.  But having said that, again you'll read that compression is very important to avoid or reduce your chances of getting them, and scare tissue developing as a result.

Can you describe what bandages you had after surgery, and what compression top you are wearing now (or other compression?) and how firm it is etc?  In your case I would think compression is even more important, just visualize how separated the tissues must be in those pockets - there is (again according to other docs on these forums) a need to keep draining, and make sure your compression is adequate.

I'd definitely go again to do drainage, and then immediately apply a lot of pressure.  You have a very experienced doc so he should be able to give you a lot of advice.  I have found some docs are far more low-key on seromas so as to not make a fuss or raise your anxiety (my doc is very serious and very experienced and does around 3-5 gyn surgeries a day plus a lot of other plastic surgery - dr lebowitz seems pretty personable, "thumbs up"!), and they aren't that big a deal in the end, but I'd be chasing very good compression if I were you in order to get that rubbery area very soft and the tissues all together so as to maximize the chances or an excellent healing result.  I'd use Ace bandages to keep it nicely flat with good pressure, is that what you are doing?

Your surgeon is going to know best because he will know how much gland was removed, your gland was minimal.  It seems seromas and swelling/lumps are more probable after larger gland removal.  It would be interesting however to hear what bandages you currently have, or top etc (how very firm it is) you are wearing?  It will also be quite important in your case I'd expect.

thanks for your reply. The compression vest i was given is called design veronique. its number 1241 if you're on their website. its black with no zipper. When the procedure was done the vest went right on with some gauze for extra pressure. it fits very well. also i was given a mini wooden roller for massaging and its working fantastic, the little lumps i was complaining about got smaller over a couple days but i made an appointment to go see him this coming Saturday. just want to make sure he thinks everything is okay/looks and feels good.

at this point in time I'm only wearing a vest with no bandages and i use the wooden roller a couple times a day. I'm happy! and feel good. =)

[Geoff88]

If you're a reader that's tried compression as I describe above and see it working, please post your experience as it will assist others who read this forum in search of help.  It should also provide support for further compression to the doctors whom seem to simply say "it'll go away, just try a massage".  I really see compression fixing my issue time and time again when hardness arises, even after the 12 week mark.

[res.Cogitans]

Dont doubt about your surgeon advice, but sometimes you are the doctor of your body.. A good compression will give you better results than a simple vest or just waiting..
Many times hard tissue/lumps go away by their own (as my surgeon also told me).. But why not do something more if you can?
I wear a sponge in the hard aera/lump, then a gynecomastia vest (veronica).. Yes its better at least 60% than just wearing only the vest..
The last days i wore a compression tshirt above the others, and i saw a slight better result (+5-10%).
Yes its uncomfortable to wear it 24/7.. But if i have to compare what is worst, i would definately choose how the hell my chest was before..
I hope the other 30%-35% will be heal/absorbed by its own.. I helped it as much as i could.

[imtakinemout]

My surgeon (one of the top in the country) said there is no need for compression past the first week. He said he did a prospective study with 100 patients in each group, one had compression on, the other didn't, and there was no difference in the final results.

[Geoff88]

Nice, you can follow his advice - but I definitely don't agree, my experience was that removing compression led to the buildup of what many people here call "scar tissue", and without compression it would have remained.  Typically I would have been told to 'massage it' and would have had less than satisfactory results.

There's numerous others reporting the same results, so perhaps compression was not sufficient in your docs samples, I found a vest was not enough, and as described above needed further compression.  It also opposes the experience of other surgeons on this forum whom take compression very seriously, and my own surgeons experience whom performs 2-3 of these surgeries per day, not in the US.  Interesting to hear a very different point of view.

[res.Cogitans]

Well, i made many tests with and without vest..
My conclusion is this: without vest the chest got hard and swollen after 1+ day. Putting on again, in half a day all the swollen area got almost flat and the hard area got smaller.
Of course, with additional pressure and not with simple vest.
My opinion is, for at least 1+ months wear your vest. 
Swells and hard areas (lumps/tissue) of course will get better by itself in time, but with more compression the result will be better. Lets say you help your body to heal more with better results.
Additionally, i do with a specific lotion massage everyday now, and believe me the hard areas got at least 5-10% less, than 4 days before.

[nasd90]

My surgeon (one of the top in the country) said there is no need for compression past the first week. He said he did a prospective study with 100 patients in each group, one had compression on, the other didn't, and there was no difference in the final results.

I’m beginning to believe this more and more... I’m 18 Days Post gynecomastia excision & Lopo surgery and at this point I am getting some hardness under the breast where he did the lipo and where the drains were... I wore it all night and when I woke up the rubbery formation was a little bigger.   Vest is starting to not feel right...

[Geoff88]

I’m conscious of the fact that many people will come to the forum to read and not post, so I’ve returned (after about a year) to support my first post above as we’re often hopeless as males to be open on a forum such as this.  For those reading through I’d say re-read my original post at very top, compression MUST be VERY firm.

With reference to the last post above I’d guess simply that the vest was not enough, and he needed bandages on top of the vest for 2-3 days.  Firm compression is the key to good results, I’ve heard just a few say the vest didn’t work - but, seriously, it most likely isn’t enough and you need to reread my original post and apply some bandages as well!

This seems to be the main post people are reading with respect to swelling, however if you search elsewhere in the forum you’ll see others responding to my suggestion too and it helped, you only have a short window of time to put “sufficient” compression in place.