Is This the Best Result Possible?

[quanta321]

I apologize to the forum moderators for opening a post to redirect to another post but I would like advise specifically from the supporting doctors on my case. My concerns pertain to the apparent puffiness of the nipple and your opinions as to whether enough tissue was removed from my chest or if I would be a suitable case for a revision. It has been about 3 years now since my surgery and the results are not necessarily much better than the post op situation. I have given myself the 3 years to hope that the swelling will subside but this seems to be the final result. I am not in too bad of shape but I definitely do have some fat that could be lost. The issue is that most of my fat resides in the chest area. If i pinch the area I can gather more fat in this area than I can from anywhere else on my body. I was told by my surgeon that excision alone should rectify the problem, but I am thinking that maybe I should have had the area lipo'd as well and may now require it to completely eliminate the protrusion. Your thoughts and advice are well appreciated in advance.

Here is the link to my case: http://www.gynecomastia.org/smf/index.php?topic=18621.0

[Dr. Elliot Jacobs]

Pictures are wonderful -- but sometimes they don't substitute for a hands-on exam.  If indeed you can pinch some extra tissue beneath the areolas, then perhaps a re-visit to your surgeon would be in order.  Sometimes the fix is a simple kenalog injection.

Dr Jacobs

[quanta321]

Would this type of injection be available from a family doctor at their discretion? 

[DrBermant]

I apologize to the forum moderators for opening a post to redirect to another post but I would like advise specifically from the supporting doctors on my case. My concerns pertain to the apparent puffiness of the nipple and your opinions as to whether enough tissue was removed from my chest or if I would be a suitable case for a revision. It has been about 3 years now since my surgery and the results are not necessarily much better than the post op situation. I have given myself the 3 years to hope that the swelling will subside but this seems to be the final result. I am not in too bad of shape but I definitely do have some fat that could be lost. The issue is that most of my fat resides in the chest area. If i pinch the area I can gather more fat in this area than I can from anywhere else on my body. I was told by my surgeon that excision alone should rectify the problem, but I am thinking that maybe I should have had the area lipo'd as well and may now require it to completely eliminate the protrusion. Your thoughts and advice are well appreciated in advance.

Here is the link to my case: http://www.gynecomastia.org/smf/index.php?topic=18621.0

I have developed special Standard After Gynecomastia Pictures that demonstrate deformity seen with excess tissues seen especially with motion and activity.  After Surgery Male Chest Video and Movies are more precise than pictures.  However, the in office examination also provides a chance to feel and best examine a problem and see how tissues move.

Firm tissues after surgery can be residual gland, but also can just be healing tissues or scars.  Different surgical techniques injure tissues to different degrees. Time to tissues softening can vary depending on the original problem, what was done, after surgery care,
Scar Care, After Surgery Compression Garments, and many other factors. Options depend on the problem to be treated. Time can range from 6 months to a year but can vary depending on many issues best explored with your doctor.

I see many patients who complain of residual Puffy Nipple Gynecomastia after another doctor's surgery.  There are many possible problems causing such a deformity.  The most common is remaining gland behind the areola as seen in these Anatomy of Puffy Nipple Drawings.  Check out the images with the link for remaining gland after surgery to see what I mean. 

Liposuction is great for fat, but does not do well for gland at all.  As shown in the anatomy link, there are usually fingers of gland between fingers of fat.  Liposuction no matter what technique (sharp cutting cannula, specially designed cannula, ultrasonic, laser, or "smart") targets the fat first.  Remove the fat and the gland remains behind condensing the fingers making a firm mass.
 
Even if the doctor achieves a flatter chest, that firm mass does not look like fat, move like fat, or compress like fat.  It just does not move well or look good (especially on animation).  That is why few doctors will show results with chest muscles tightened or arms up over the head or movies showing the tissues in motion.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia Surgery

[quanta321]

After a more careful feel I have found there to be very minute hard lumps under each areola. They are located just underneath the excision marks and I'm hoping that this is scar tissue not excess or regrown glandular tissue. Is puffiness like this a common symptom of scar tissue. What should scar tissue feel like? Is it supposed to be visible at the surface or felt underneath as I am feeling?

[Dr. Elliot Jacobs]

Scar tissue can be soft or firm or in-between.  No-one can know if you have scar tissue or more rarely, a re-growth of breast tissue.

Best to return to your original surgeon and discuss some possible options.  Anything more from the surgeons on this site is pure guesswork.

Dr Jacobs

[DrBermant]

After a more careful feel I have found there to be very minute hard lumps under each areola. They are located just underneath the excision marks and I'm hoping that this is scar tissue not excess or regrown glandular tissue. Is puffiness like this a common symptom of scar tissue. What should scar tissue feel like? Is it supposed to be visible at the surface or felt underneath as I am feeling?

Everyone has healed from cuts before.  Scar tissue is the response of the body in healing and involves the entire surgical sculpture from the skin to the deepest operated tissues.  Scar tissues can be felt when they are firm and seen when the tissues move with adhesion.  Such issues are best explored with your surgeon or someone familiar with the specific details of your situation.

Hope this helps,

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