Please Help/5 months after surgery/Photos included

[shalala2012]

I developed puffy nipples at 12 years old when reaching puberty. The right side was always bigger than the left. I am now 6'2" 180lbs. I had gynecomastia repair and liposuction with the use of drains on both sides April 13,2010 by a board certified plastic surgeon. There was a complication on the right side from hemotoma and it was swollen like a balloon. It eventually went down and it is now the size it was before the surgery. My left side was PERFECTLY FLAT for a few months after the surgery and it has now regained puffiness and has the same hard rock under the nipple as before. My doctor scheduled a revision surgery for Nov 02,2010 only on the right side. He told me to "not worry about the left side". He said he will use a larger drain this time (The drains left a larger scar than the incision). I was concerned about regrowth and  asked if I should see a endocronoligst and he said it was not necessary. He insists that this will be the last time I will ever have to go through this again. Both nipples are tender and have a clear discharge when squeezed as they did right before the gynecomastia devolped at 12 years old. BTW: I took it upon myself to meet with my personal physician yesterday and had him refer me to the endocrinologist next month. I want the best results possible and definitely do not want to go through this again! Below are some questions and photos of 5 months after surgery.

Questions:
    Is the left nipple regrowth or scar tissue. Should I suggest that he uses a kenelog shot?

Does a revision surgery typical make the scars more noticeable?

Any suggestions?

[George Pope, M.D.]

Your photos are too tight, too close up.  It would help if you showed more of your chest, with additional views.  Your left side looks good in these photos, but if there's something under the nipple/areola that's "rock hard", it's probably scar tissue.  A Kenalog injection could possibly help that.  You could certainly ask your plastic surgeon about that.  On your right side you could have some residual gland tissue, or possibly scar tissue buildup as a result of the hematoma; hard to say.

At any rate, I never tell patients that this is the last time they'll have to go through a procedure; that's impossible to predict.
And there's no rationale behind using a larger drain, in my opinion, unless the first drain was way too small for the procedure performed.  Drains do not guard against a hematoma, or heavy bleeding.  They help prevent buildup of blood and serum (liquid part of blood without red blood cells) that naturally develops from the raw surfaces created in a procedure.  But, if an artery or vein of any substantial size opens up and starts bleeding, you're going to get a hematoma that the drain can't handle.  Hope that makes sense.

Good luck-
Dr. Pope, MD