Hard tissue

[robertirvinne]

Hi,

I recently underwent surgery for mild gynecomastia (puffy nipples) at the end of January. The surgeon managed to get the tissue out via liposuction and no nipple incision was necessary. The results are great - my nipples are still a tiny bit puffy, but the tissue on the breast behind them has been removed and contoured to make it a much more normal chest. However, I now have very hard breast tissue underneath my nipples. This does not affect the appearance of my chest, and even though it is not particularly painful, it is a bit uncomfortable and has a strange sensation.

I went for my 6 week post-op check-up with my surgeon last week. He said I no longer have to wear my compression vest, and that it should be fine just to massage this hard tissue whilst I am applying the vitamin E oil on the liposuction incisions (morning and night). Then the hard tissue should eventually disappear.

However, I am slightly skeptical, and I wanted to ask if there is anything else I could be doing which may help soften this tissue. Are there any specific oils or ointments that I could use which may help soften the tissue (perhaps even homeopathic treatments)? And will this hardness actually disappear over time, or will further surgery be necessary? I see from other posts that Kenalog injections have been talked about - would this be a solution to my problem?

Thanks,

Robert 

[DrBermant]

Hi,

I recently underwent surgery for mild gynecomastia (puffy nipples) at the end of January. The surgeon managed to get the tissue out via liposuction and no nipple incision was necessary. The results are great - my nipples are still a tiny bit puffy, but the tissue on the breast behind them has been removed and contoured to make it a much more normal chest. However, I now have very hard breast tissue underneath my nipples. This does not affect the appearance of my chest, and even though it is not particularly painful, it is a bit uncomfortable and has a strange sensation.

I went for my 6 week post-op check-up with my surgeon last week. He said I no longer have to wear my compression vest, and that it should be fine just to massage this hard tissue whilst I am applying the vitamin E oil on the liposuction incisions (morning and night). Then the hard tissue should eventually disappear.

However, I am slightly skeptical, and I wanted to ask if there is anything else I could be doing which may help soften this tissue. Are there any specific oils or ointments that I could use which may help soften the tissue (perhaps even homeopathic treatments)? And will this hardness actually disappear over time, or will further surgery be necessary? I see from other posts that Kenalog injections have been talked about - would this be a solution to my problem?

Thanks,

Robert 

6 weeks months can be very early after surgery with some techniques.

Posting Standard After Gynecomastia Pictures can help other better understand your concerns.

Early after surgery swelling can mask residual deformity.  How Tissues Evolve After Gynecomastia Surgery depend on many factors. 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 really find that a Second Stage Compression Garment and the scar care can make a difference on the evolving tissues. They will not help with the remaining gland component.


The body typically needs to heal before considering revision surgery. Rushing into secondary surgery can be a mistake unless there are complications that need to be addressed or the next surgery is component of a staged procedure. 

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 Chest Sculpture

[Dr. Elliot Jacobs]

Six weeks after surgery is probably the height of the expected firmness after surgery.  Strange feelings are also very common at this stage.

This is the point when nothing should be done because there is active healing going on -- and the only thing sure about your condition is that it will be changed in another few months.

Also, please bear in mind that what you may have is swelling/scar tissue/possible residual gland -- but one cannot tell and one must not start to treat at this stage.

Just remember, the purpose of gyne surgery is to provide a nice visual contour to your chest.  Other people do not go around pinching your chest after the surgery to check if "all of the gyne has been removed."  There is always some scar tissue after any surgery, including gyne surgery.  What counts is the final appearance -- not what one can feel under the skin.

Dr Jacobs