post op questions and my pics

[Jan1010]

I had my resection gynecomastia surgery on Jan 6, 2010 and am now over four months post-op.  I started lifting again about two months ago and still wear my wrap every so often.  I did not, however wear my compression wrap as much as I should have in the first few weeks because it is so terribly inconvenient (as I am a student).  There are now lumps under each nipple that are painful sometimes and are bigger sometimes compared to other times and my nipples are very sensitive.  When I do wear my compression wrap (especially if I use gauze on the nips for extra pressure) it totally alters the way my 'lumps' feel and look.  It looks and feels just like my old gyno (with the slight exception that if I play with it (i.e. massage) it seems to break up pieces around it, but the main nucleus of the 'lump' stays intact and is very hard).  Is this just swelling? or perhaps something worse?  My doctor has been performing this surgery for over 15 years and I trust him I am just nervous because this looks and feels like the gyno I had, and you know what they say if it looks like a duck and quacks like a duck...its probably a duck.  Am I overreacting?  He says it should go down and eventually be completely gone and that all of the breast tissue was removed.

Also, let it be noted that immediately after my surgey I was flat without the presence of any 'lump' just some fluid like swelling.  In fact I was so flat that my one nipple even creased in a bit (nothing too bad and I would be more than happy if that was my final result).

Also, let it be noted that the lump on the left side is about twice the size of the one on the right, just as my gyno was before surgery.  Don't know if that is a good sign or bad.

Below are some pics of mine.  Please note that they were taken after icing and make my chest look almost perfect, however most of the time my chest protrudes a bit because of the lumps described above.  I would really appreciate it if anyone can shed some light on what the above mentioned lumps are.  The pics are as follows: Chest unflexed, Chest flexed, view from the top- left/right respectively, and a view from the right side.

Thanks all, God Bless.

Michael

[Dr. Elliot Jacobs]

Don't know what you looked like pre-op, but these post op results look good.

However, the story you tell sure sounds like you developed some scar tissue -- it can't be swelling at this stage.   The tenderness and lumpiness all go along with the concept of scar tissue.  This is not uncommon after gyne surgery.

It would be wise to return to your surgeon to discuss this issue.  One possible treatment is with kenalog, which will melt away scar tissue without any additional surgery.  Just as you needed an expert to do your original surgery, you need an expert who is experience in the administration of kenalog (it is a strong medication which can have local side effects if not injected properly).  I would def not consider re-operation to remove scar tissue -- you would only heal with (you guessed it) more scar tissue.

Good luck -- let us hear what your PS says.

Dr Jacobs

[Jan1010]

I am due to see my PS in august, should I just wait til then to bring it up or would a kenalog injection be more effective now then later in the game?  Also, why is it that with compression the 'scar tissue' changes size and consistancy?

Thanks for the reply

[Dr. Elliot Jacobs]

There may still be some swelling associated with the scar tissue -- and that may account for the changes with compression. 

There is absolutely no harm in waiting -- perhaps a bit of massage may be of help as well.  Kenalog will work on scar tissue at any time -- whether is is six months after surgery or years after surgery.

Dr Jacobs

[ddh]

My surgery was on Feb 10 and I too have small, hard lumps under each nipple.

I keep massaging them, and maybe they are getting a bit smaller.  I see my PS in a couple of weeks and plan to ask him about the hard lumps. I'll post whatever he has to say.

BTW, you have a great looking result from your surgery! Congrats!

[Jan1010]

How does the kenalog work? Is it always effective? and What can I expect to remain behind the nipples after a kenalog treatment?

Thanks

[Dr. Elliot Jacobs]

There is no human scar tissue that is resistant to kenalog.  Sometimes, due to the large extent of the scar tissue, multiple injections may be required.  Kenalog causes atrophy of the scar tissue with volume reduction and substantial softening of the tissues.  Generally, it can be done at any time after 6 months of surgery.

Dr Jacobs

[Jan1010]

There is no human scar tissue that is resistant to kenalog.  Sometimes, due to the large extent of the scar tissue, multiple injections may be required.  Kenalog causes atrophy of the scar tissue with volume reduction and substantial softening of the tissues.  Generally, it can be done at any time after 6 months of surgery.

Dr Jacobs

Does it cause atrophy to the muscle as well?

[Dr. Elliot Jacobs]

It can cause atrophy of the muscle if it is injected improperly.  Kenalog works locally -- where it is injected -- it does not spread.  That is why you should make sure your doctor is expert in doing injections of this type.  It must be accurately injected only into the scar tissue -- and in just the right dose.

Dr Jacobs