Question about healing at after 6 months.

[winston001]

I'm at 6 months now post op, although happy with the results in comparison to how it was I still feel there's room for improvement. I was wondering at 6 months could I still see some improvements in the look of my chest, for instance the nipples were flat after the operation but since then look slightly puffy again, I do get a strange sensation behind them I have been told is fluid, could this cause the slight puffiness, I've also read scar tissue can cause the nipples to look puffy, I was told all gynecomastia was removed so what could cause this. Thankyou.

[Dr. Elliot Jacobs]

Best to return to your surgeon -- he knows exactly what was done.

If he is sure that he removed a substantial amount of tissue, then perhaps it is scar tissue that has grown under the areolas.  In that case, one might consider a kenalog injection to help you.  Doubt if there is any fluid there -- especially after six months.

Dr Jacobs

[DrBermant]

I'm at 6 months now post op, although happy with the results in comparison to how it was I still feel there's room for improvement. I was wondering at 6 months could I still see some improvements in the look of my chest, for instance the nipples were flat after the operation but since then look slightly puffy again, I do get a strange sensation behind them I have been told is fluid, could this cause the slight puffiness, I've also read scar tissue can cause the nipples to look puffy, I was told all gynecomastia was removed so what could cause this. Thankyou.

There should be no residual fluid that long after surgery. By 6 months most of the results should be apparent with most techniques. Some methods with greater injury to recover from can take up to a year.

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, fat, but also can just be healing tissues or scars.  Different surgical techniques injure tissues to different degrees.  By 6 months that swelling should be resolved.

I see many patients who complain of residual "Pufffiness" and 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.  

Here are just a few of the many examples I have seen and treated:

• Revision Gynecomastia After Failed Liposuction By Other Surgeon
• Revision Puffy Nipple Gynecomastia After Failed Liposuction By Other Surgeon
• Revision Gynecomastia After Liposuction and Partial Gland Excision By Other Surgeon.
• Revision Gynecomastia After Partial Gland Excision
  

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.  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.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia Chest Surgery

[winston001]

Thanks for answering.

When I last saw my surgion at just over 5 months I adressed the issue of the nipples not looking completely flat and he said that no ones nipples are flat it just wouldn't look right, yet before the surgery I said so this area (puffy nipples) will be flat and he said yes. Very confused.

If there were scar tissue would it go on it's own over time or only with those injections.

Thank you for your time.

[Dr. Elliot Jacobs]

I disagree with your surgeon.  A normal male nipple (really a nipple-areola) will have a flat areola which is continuous with the surrounding skin.  It should not bulge -- as in a dome or a tent.  The small nipple itself, of course, should indeed bulge slightly.

It might be wise for you to obtain a second opinion by an experienced gyne surgeon.  Sometimes an injection of a steroid, such as kenalog, can help.

Dr Jacobs

[DrBermant]

Thanks for answering.

When I last saw my surgion at just over 5 months I adressed the issue of the nipples not looking completely flat and he said that no ones nipples are flat it just wouldn't look right, yet before the surgery I said so this area (puffy nipples) will be flat and he said yes. Very confused.

If there were scar tissue would it go on it's own over time or only with those injections.

Thank you for your time.

A flat areola on a curved contour of a muscle will look weird. The ideal shape of the areola should continue the curve of the muscle without additional projection except for the anatomic nipple itself. When compromise surgery is done on an overweight individual this curve will not fit the muscle but the general fat of the region. Scar tissue issues are not the only thing that can cause contour problems. The most common is residual gland when the gland is not targeted first.  Injections will not help contour problems from remaining gland causing deformity.

You have posted many times since surgery, but yet have show the forum before / after surgery photos. A surgeon's own before surgery patient education, and website or photo collection of before / after results, should be close to the after surgery results.

Hope this helps,

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

[winston001]

Thanks for your replies, I guess I will have to go back and see my surgion again and tell him Im not happy with the end results and maybe push for a
second operation.

Thanks again.