Incomplete Gland Removal or Swelling?

[Justsaynotopuffynips]

Greetings, it's been six and a half weeks since my surgery (excision of glands only that I had since puberty).  My right side currently puffs out similar to the way it did prior to surgery (photos attached) while the left side lays flat.  However, the left side creases when in a hot room or flexing.  The only time my chest looks good is when my nipples are hard - the same as before surgery.

I've read here that one must wait 6-9 months before drawing final conclusions.  My surgeon said he would check it out and perhaps a revision is necessary on the right side.

My question is: could this be swelling or is it incomplete gland removal?  He said he removed all of the glandular tissue.

He removed the stitches quickly, just three days after the operation (he said there were internal stitches as well).  This led to the right side (where I had a hematoma) pushing out while it healed, which created a shelf at the bottom of the areola so to speak.  I don't know whether the skin will fill in over the coming months.

PS He did drain the hematoma on the puffy side, and it looked good for about a day.

The first photos are the current state of my chest while the following photos show the glands he removed and my chest right after surgery.  The pic right after surgery is a bit deceiving since my nipples were hard.

[Justsaynotopuffynips]

Here are additional photos:

1.) Front view to see the asymmetry.

2 & 3.) Another example of the asymmetry (these were taken before the pictures in my first post).

4.) The hematoma or seroma before he drained it (this was on the side that is currently puffy).

I've done some massaging the past few days, and I think it made it worse.  They are still a bit tender.

[Justsaynotopuffynips]

And finally, here is where the separation between the areola and surrounding skin occurred during healing. This caused the current "shelf" at the bottom of my right nipple.  At the time, my surgeon told me not to worry because everything would reconnect.

[Litlriki]

At this stage in healing, many of the things that you're observing are temporary and will change over time. There are often minor asymmetries in the healing process.  I tell my patients that I won't talk to them about revisions before 9 months to a year except in rare instances where something will obviously not resolve. Have patience and keep in touch with your surgeon. 

[Justsaynotopuffynips]

Thank you, Dr. Silverman.  I've been in touch to visit my surgeon.  He gave me some Dermatrix gel, and it's helped to soften the incision sites.  He said the right side might need a minor revision.
I'm doing my best to have patience and feeling better about it.  My advice to other guys is to get this done as early as possible.  I remember going to the doc with my dad about it when I was 12, and the doc said it would go away in time.  Here I am 22 years later still battling the beast.
I'm leaving the country in a couple of days to continue my travels.  My surgeon is going to inject me tomorrow to see if that helps since I don't plan on returning here for a revision.  If worst comes to worst, I'll find a new surgeon later, but at this point, I'd rather get back in the gym and live with one puffy nip.
At 7 weeks after surgery, I have yet to weightlift (one of my favorite activities) because I didn't want to disturb the healing.
I'll update this later to give guys some insight on puffy nipples after surgery since I know that's a hot topic here without a lot of photo evidence or followup information.

[Dr. Schuster]

The photo of surgery suggests that the gland was indeed removed. The residual puffiness is mild and could be the result of just a little bit of residual gland (it's hard to get things perfect every time) or scar tissue (which is more likely considering this is the side you had the hematoma). Steroid injections can help reduce the scar tissue. I think it is safe to have them done at 3 months after surgery (or maybe a little earlier if the surgeon is sure the scar tissue is building up). If it remains you might need a small revision but I would recommend waiting till 6 months after surgery to do. Good luck.

[Justsaynotopuffynips]

Hey, I just wanted to update this to let everyone know my surgery was unsuccessful. I did have one round of steroid injections that didn't help. My right side looks even puffier than the photos above and worse than before surgery. The left side is slightly puffy as well. I've been in the gym a lot more, and the muscle building beneath has worsened it.

I'm currently on the hunt to find a surgeon who can get it right since I lost confidence in my original surgeon. However, I have no idea when I'll be able to fit it in. 

My advice to guys is to only go to surgeons who post photos of consistent successful final results at least 10 months post surgery. If not, you could get a dud like me. Also, I think excision only is a bad idea even if you don't have much fat for liposuction like me. Now I can see how the surgeon must shape the chest for everything to work out. The surgery is more complicated than I realized.

Cheers,

From the guy who still has gyno 

[Dr. Elliot Jacobs]

You are correct in this regard:  puffy nipple surgery is tricky.  Some patients (and some surgeons as well) may be fooled because it is small and appears to be a "no-brainer" of a procedure, but as you can see, there are potential problems.  That is why it is best to go to a gyne expert if at all possible.  You will then have the best chance to get it right the first time.

Dr Jacobs

[Dr. Schuster]

Sorry to hear that you did not get the result you wanted. Yes, I think that gynecomastia is much more difficult to get a great result than most surgeons and patients think. Hopefully patients will listen to the great advise that the surgeons on this sight give out for free!