Did I make a really big mistake? 2 weeks post-op HELP

[NedStark]

So if you follow the album you will see that I am obese and did have pubertal gyno exacerbated by finasteride use. It has rapidly increased the last year or two which is why I went to an endocrinologist. Eventually she told me I should see this really good surgeon, who will excise the gland, simple procedure, freezing blah blah. Don't think she had a clue. This doctor then does a full subcutaneous mastectomy. This is the result. I feel so depressed and upset. I should have visited this forum earlier. I feel like my nipple looks butchered. Like he cut through 1/4 of it and I have this giant scar and also crater. He also put in this drain tube that under the skin feels like a tunnel still. I have a second surgery planned for the right side, as he stated he only does one at a time, but I would rather pay good money to a proper plastic surgeon. Is there any hope to save the left? Should I lose all my weight? It has really motivated me to get to a super low and stable weight and then try and correct. Can any of you amazing doctors salvage this? I would rather still have had my gyno and way my breasts looked then how the left looks now.

[Litlriki]

It appears that most likely, only excision of a portion (or most) of the gland, and no liposuction was done.  In the end, this may benefit you.  You should find a gynecomastia surgeon to address your issue, rather than the general surgeon you've seen.  The surgeon may be able to give you improvement on the already operated side with some liposuction, which can help to resolve the crater, and address the right side comprehensively.  There is no reason to do these procedures piecemeal as your previous surgeon's approach seems to entail. 

[NedStark]

Sorry the image formatting is all messed. Yeah it is because I was referred to by an endocrinologist. He said he only wanted to do one at a time and even used a drainage tube which has left a small scar. Is lipo beneficial if I am obese. This has spurred me to change my diet and get in shape and I am already down 11 pounds since the day of the surgery so hopefully I can shed more weight. I have been somewhat emotional looking at hoe my nipple looks. I think he was very poor with his suturing as well.  I have been using polysporin on the very left side and have even bought quite expensive silicone gel and silicone scar sheets to try and improve how it will look. So should I cancel the upcoming subcutaneous mastectomy on my right side and just wait and heal up and see a proper gynecomastia surgeon? Full gland removal would seem to benefit as my endocrinologist stated there is some issue with hormones, probably exacerbated by obesity and use of things like Finasteride. I was feel self conscious with my shirt off at the beach due to the increasing gyno which started to make my nipples stand out like mountains through shirt. Now with the left nipple looking like it does, the crater, the inversion and scars, I feel like I would not go shirtless ever. How long is healing time? I don't have much pain as there was no lipo and there is only some swelling or lumps near where tube was inserted. Is waiting 6 months enough to visit a proper plastic surgeon who can operate on right and then sort of fix left? We always hear the horror stories of revision surgery being bad, but in your honest opinion, can my nipple ever go back to how it was or close to normal looking?

[NedStark]

Also looking at the nipple itself did he botch the suturing? It looks likr he completely halved the side. I honestly regret it and feel conned into having gone to this general surgeon.

[Dr. Elliot Jacobs]

I cannot understand why a surgeon woulod do only one breast when both sides obviously have a problem.

Yes, your obesity will limit what can be achieved with proper gyne surgery -- but you should still see a substantial improvement even at your present weight.  If you can lose weight in the meantime, it would be a big plus.

It is important to be patient and to allow full healing to occur before considering revision on your breast.  Then, please, get an opinion from a gyne expert in your area.

Dr Jacobs

[NedStark]

His reasoning was due to potential complications. I honestly feel like I was conned. I accept responsibility because I am a grown adult, but what I was told by my endocrinologist and what this general surgeon did do not match up. Additionally, he told me that I needed the drain tub which has left another small scar. The worst is that I feel he haphazardly did the excision and sutures because my circular nipple now has a corner feel like it is gone like he cut and stitched through rather than half moon under it like he said.
I was very emotional for the week after. No comprrssion vest, seeing the crater. I will look for local gyne plastic surgeons, but in your professional opinion, is there any hope to salvage a normal appearance anymore? Or will I always look butchered which is how I feel. I bought silicone gel sheets and tube to try and counteract scarring. I will honestly wait an entire year to heal if that is what is needed for revision. I am just worried about further scarring.

[Dr. Elliot Jacobs]

Yes, there definitely is hope for revision surgery.  But again, give it time to heal and try to lose weight in the meantime.

Dr Jacobs

[NedStark]

Dr. Jacobs in your expert opinion, I am booked with this general surgeon for the right breast in a few weeks. Should I cancel and seek out a professional gyne plastic surgeon cost no bar?
I see this general surgeon for a followup in a week. Is there anything I should ask him that would be beneficial for surgeons like yourself if you were doing the revision a year from now or operating on the right. How much gland removed, potential complications, etc. What information should I have moving forward. I honestly don't understand why my endocrinologist referred me to this surgeon or why the surgeon would accept when it seems it isn't his forte. I wish more worked with professional plastic surgeons and people like me were given better information and advice.

[Dr. Elliot Jacobs]

I dont know this new general surgeon and I have the utmost respect for general surgeons.  However, plastic surgeons are much more involved overall in treating gynecomastia and would more than likely provide a better result for you.

Why rush into treating the other side?  Even if you had a perfect result on the new side, you would then have to wait for revision on the first side and you would be lopsided in the interim. You will most likely need surgery on the first side -- so why not wait and get both sides done by an experienced gyne surgeon?

Your call.

Dr Jacobs

[NedStark]

I guess I have no other choice. I wonder how I will heal. I look at my nipple and it is missing a giant chunk which I am assuming was poor scalpel cutting through or poor suturing with the dissolvable sutures.
The only reason I even did it now was the increasing gyno, the pain around the nipples if I laid flat or someone pressed in. Who knows in one year how much the right side will be. Thank you again Doctors. I will see the general surgeon on the 25th, tell him we won't proceed on the the right and then begins the one year healing and weightloss before I get it properly done with a professional.

[NedStark]

So it has been about 4.5-5 weeks post-op. The nipple has filled out a bit so I don't have as bad a crater deformity. When I flex the nipple does cave in and there is the crater. I did see the general surgeon. He told me he was happy with the results as I had no infection etc. But he said I can always have a revision for the scar. Here is how it looks. He couldn't explain why it happened. I feel it was poor suturing technique and bandaging. I canceled the right breast surgery and will hold off. But for you doctors that specialize, is this something that could be fixed with the revision? I absolutely hate the drain tube scar, one side of the nipple has a bump, the other side just really bad scarring. Please advise. I honestly have been emotional and wish I had never done it in the first place.

[Dr. Elliot Jacobs]

Most often, revision surgery can improve craters, scars, etc -- but it cannot remove a scar and replace it with virgin tissue.  Your drain tube scar may require scar revision, but it will always be there.  Fortunately, scars tend to fade in time and eventually should be nearly inconspicuous.

You are now in the earliest stages of healing.  While it may be difficult to accept, the best course of action at this time is not to dwell on what has occurred but to be patient and then consult an experienced gyne surgeon in your area for consideration of revision surgery.

Dr Jacobs 

[NedStark]

The drain tube scar is actually the small half centimetre mark off to the side. The massive scar right near the edge of nipple is what I am most concerned with. The surgeon just stated this is something that could happen. Thin skin, I should have expected unacceptable scarring etc. But I feel it has to be improper suturing or bandaging. He even tried to say that I didn't understand the stress of a general surgeon over making sure things go right. But I am the one who lives with the surgery and the scars.

It is hard to not dwell on it because I feel I will be scarred for life now and never have a proper nipple. Plus with the surgeon doing full gland excision on the left side only, I have a lopsided look. One side is puffy and pointy with gyne on the breast and the other is cratered and scarred.  I agree that scar can never be replaced with virgin tissue, but would revision at least sort of cut some of the scar tissue away, maybe suture virgin skin a bit closer? I did buy silicone gel sheets, silicone gel and polysporin and even bio-oil thinking they would help. Thank you again for your invaluable expertise doctor.

[Dr. Elliot Jacobs]

In many cases, a poor peri-areolar scar can be improved -- there is hope.

Dr Jacobs

[Dr. Schuster]

I realize I'm just getting into the middle of this but I would agree with Dr. Jacobs that there is no reason to go forward with the second side if you are already unhappy with the first. Take a step back and don't rush into it if you are having second thoughts. Also, photos would be quite helpful.