Concerns Post Surgery- Any Opinions Welcome

[dragonfire]

Here are my pics below almost 7 weeks post surgery. I used the same well known doctor that Rocky76 used. I have concerns with the results. First off the incision on he left nipple appeared jagged and  that it went to far wide. It was a concern from day after surgery and you can see why 7 weeks after. Also right nipple looks ok, but bottom of nipple is puffed up. Its like the scar from the incision it puffing it up. Also I don't know if its loose skin or fat. Whole area around nipples still seems and appears slouchy.

Ok figured how to post pics. I guess if you click on them they get a little bigger.

[DrBermant]

Here are my pics below almost 7 weeks post surgery. I used the same well known doctor that Rocky76 used. I have concerns with the results. First off the incision on he left nipple appeared jagged and  that it went to far wide. It was a concern from day after surgery and you can see why 7 weeks after. Also right nipple looks ok, but bottom of nipple is puffed up. Its like the scar from the incision it puffing it up. Also I don't know if its loose skin or fat. Whole area around nipples still seems and appears slouchy.

Ok figured how to post pics. I guess if you click on them they get a little bigger.

Wide incisions beyond the edge of the areola are difficult to hide and do not look natural. Over time most scars improve, especially when using some form of after surgery Scar Care.

Your limited pictures only partially tell the story. If you post a Standard Set of After Gynecomastia Surgery Pictures, others can better understand your concerns. Problems can be there with the surface scar, but also with deeper elements that show up more with animation.

Residual contour problems can take many forms. Some doctors' techniques result in more swelling than others, so evaluating the Evolution of After Gynecomastia Surgery Tissues is really doctor / technique dependent. Options depend on many factors but normally need to wait until tissues heal.

Hope this helps,

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

[Rocky76]

Hey Dragonfire, I'm no professional but it seems you have some loose skin issue causing some of the irregularity. Did you lose much weight from a previous time? Was the masses removed very large? I also see what you mean about the left side nip..thats not a very neat cut he made. Possibly with healing the scar will have less ripple effect hopefully. Do you have any before pics?

[DrBermant]

Does anyone else have any more input or comments based on the additional pictures I have provided.

Thanks

There seems to be contour issues. You best bet for specific recommendations is best reserved for a consultation where the original problem, details of what was done, weight, fat, and other concerns brought into the equation. But for most unhappy with their first surgeon, the initial step is often waiting to see how tissues evolve.

Hope this helps,

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

[dragonfire]

Hey Dragonfire, I'm no professional but it seems you have some loose skin issue causing some of the irregularity. Did you lose much weight from a previous time? Was the masses removed very large? I also see what you mean about the left side nip..thats not a very neat cut he made. Possibly with healing the scar will have less ripple effect hopefully. Do you have any before pics?

No this is the heaviest and most out of shape I have been. I dont really have any before pics I might be able to find one, but nothing close up on the chest. I'm mostly concerned about the scar on the left side I can post a closer image, but I showed about 10 people now and in person and they immediately can notice something was down and then can notice the scar. It pulls/ stretches my nipple out to the side like a football and in person its very dark scaring and jagged. It looks like Pac-man bit it in person on the bottom. I dont know how big they were I was not told or spoken to after the surgery. The Doctor was rushing and already in another surgery because he was 1hr behind his schedule. I do have the pathology report with how big they were and can post up that.

[DrBermant]

Hey Dragonfire, I'm no professional but it seems you have some loose skin issue causing some of the irregularity. Did you lose much weight from a previous time? Was the masses removed very large? I also see what you mean about the left side nip..thats not a very neat cut he made. Possibly with healing the scar will have less ripple effect hopefully. Do you have any before pics?

No this is the heaviest and most out of shape I have been. I dont really have any before pics I might be able to find one, but nothing close up on the chest. I'm mostly concerned about the scar on the left side I can post a closer image, but I showed about 10 people now and in person and they immediately can notice something was down and then can notice the scar. It pulls/ stretches my nipple out to the side like a football and in person its very dark scaring and jagged. It looks like Pac-man bit it in person on the bottom. I dont know how big they were I was not told or spoken to after the surgery. The Doctor was rushing and already in another surgery because he was 1hr behind his schedule. I do have the pathology report with how big they were and can post up that.

The normal Male Body Fat Distribution is to put fat first on the belly and chest. Surgery at a weight someone is unhappy with makes no sense to me. Weight loss before surgery is better than a gamble with weight loss after. You cannot pick where the fat comes from. Men tend to lose fat last from chest and belly. Contour the chest, lose the weight, and if the weight comes off in the natural fat pattern, then it will look like the gynecomastia has returned.

Why do you think your doctor was rushing "for another surgery" or "behind his schedule?"

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[dragonfire]

Hey Dragonfire, I'm no professional but it seems you have some loose skin issue causing some of the irregularity. Did you lose much weight from a previous time? Was the masses removed very large? I also see what you mean about the left side nip..thats not a very neat cut he made. Possibly with healing the scar will have less ripple effect hopefully. Do you have any before pics?

No this is the heaviest and most out of shape I have been. I dont really have any before pics I might be able to find one, but nothing close up on the chest. I'm mostly concerned about the scar on the left side I can post a closer image, but I showed about 10 people now and in person and they immediately can notice something was down and then can notice the scar. It pulls/ stretches my nipple out to the side like a football and in person its very dark scaring and jagged. It looks like Pac-man bit it in person on the bottom. I dont know how big they were I was not told or spoken to after the surgery. The Doctor was rushing and already in another surgery because he was 1hr behind his schedule. I do have the pathology report with how big they were and can post up that.

The normal Male Body Fat Distribution is to put fat first on the belly and chest. Surgery at a weight someone is unhappy with makes no sense to me. Weight loss before surgery is better than a gamble with weight loss after. You cannot pick where the fat comes from. Men tend to lose fat last from chest and belly. Contour the chest, lose the weight, and if the weight comes off in the natural fat pattern, then it will look like the gynecomastia has returned.

Why do you think your doctor was rushing "for another surgery" or "behind his schedule?"

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

Hello doctor. So are you saying if I loose weight after I had surgery it will most likely look like I have gyno again. Whats the best option to do at that point? Hope the skin tighten up or go back for lipo sculpting in the chest area.This i somewhat disappointed if thats the case because I could have waited and lost 30lbs before having the surgery, but was not told by the other doctor this could impact my results or to consider it. The doctor was rushing because the anesthesiologist was accidentally booked an hour late by the doctors office and several people in the waiting room including the person who brought me were talking about how the doctor was rushing when I as brought out from surgery.

[DrBermant]

Hey Dragonfire, I'm no professional but it seems you have some loose skin issue causing some of the irregularity. Did you lose much weight from a previous time? Was the masses removed very large? I also see what you mean about the left side nip..thats not a very neat cut he made. Possibly with healing the scar will have less ripple effect hopefully. Do you have any before pics?

No this is the heaviest and most out of shape I have been. I dont really have any before pics I might be able to find one, but nothing close up on the chest. I'm mostly concerned about the scar on the left side I can post a closer image, but I showed about 10 people now and in person and they immediately can notice something was down and then can notice the scar. It pulls/ stretches my nipple out to the side like a football and in person its very dark scaring and jagged. It looks like Pac-man bit it in person on the bottom. I dont know how big they were I was not told or spoken to after the surgery. The Doctor was rushing and already in another surgery because he was 1hr behind his schedule. I do have the pathology report with how big they were and can post up that.

The normal Male Body Fat Distribution is to put fat first on the belly and chest. Surgery at a weight someone is unhappy with makes no sense to me. Weight loss before surgery is better than a gamble with weight loss after. You cannot pick where the fat comes from. Men tend to lose fat last from chest and belly. Contour the chest, lose the weight, and if the weight comes off in the natural fat pattern, then it will look like the gynecomastia has returned.

Why do you think your doctor was rushing "for another surgery" or "behind his schedule?"

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

Hello doctor. So are you saying if I loose weight after I had surgery it will most likely look like I have gyno again. Whats the best option to do at that point? Hope the skin tighten up or go back for lipo sculpting in the chest area.This i somewhat disappointed if thats the case because I could have waited and lost 30lbs before having the surgery, but was not told by the other doctor this could impact my results or to consider it. The doctor was rushing because the anesthesiologist was accidentally booked an hour late by the doctors office and several people in the waiting room including the person who brought me were talking about how the doctor was rushing when I as brought out from surgery.

It is not completely predictable just how the weight comes off. It is a gamble. I view this as surgical sculpture and why I advise my patients to do the coarse work (weight loss) first and then the refinement, the plastic surgery, later. But each doctor has his / her own methods.

Hope this helps,

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

[Rocky76]

I think the doctors preparations and planning are piss poor. Had I been consulted properly and explained what was going to be done I wouldn't have been lipo'd. We are kinda on the opposite ends of the spectrum. I was to lean to be lipo'd. I have irregularities in the contour of my chest. So far as the swelling goes down it seems to be getting worse not better like the Dr. said it would. He basically left me with a dent on my right side. I can't believe this sh!t is happening.

The doctor really needs to slow down and take every case more seriously and stop with the I do the most surgery's of any Dr in the world crap. He needs to get back to quality not quantity.

Which all leads to another issue... how in the world can someone comfortably go back and get a revision with the same doc that screwed it up to begin with? I just don't see how that makes good sense. Does that ever work out?

[dragonfire]

Which all leads to another issue... how in the world can someone comfortably go back and get a revision with the same doc that screwed it up to begin with? I just don't see how that makes good sense. Does that ever work out?

I wonder as well. Maybe one of the docs could chime in...I hope so because I have no funds left for someone new.

[DrBermant]

Hello doctor. So are you saying if I loose weight after I had surgery it will most likely look like I have gyno again. Whats the best option to do at that point? Hope the skin tighten up or go back for lipo sculpting in the chest area.This i somewhat disappointed if thats the case because I could have waited and lost 30lbs before having the surgery, but was not told by the other doctor this could impact my results or to consider it. The doctor was rushing because the anesthesiologist was accidentally booked an hour late by the doctors office and several people in the waiting room including the person who brought me were talking about how the doctor was rushing when I as brought out from surgery.

Weight loss before surgery is normally the better way to go. The exception for my patients is for those with need of local resources for rebuilding defects like a crater deformity. For these individuals, weight loss before surgery can deplete potential nearby tools for fat with a blood supply. Weight loss after this surgery will become a gamble as to how it will come off. Such risks are best discussed by the surgeon considering revision.

I had surgery back in Nov. 2010 and May 2011 revision to left nipple pulling to left making in football shaped. Left nipple not pulling any longer , but scar is very pronounced now. While I was having revision I told doctor my right nipple has been bothering since surgery. It puffy and hurts. I think its from the scar tissue the way it healed it pushes out the nipple, but its always sore. I was wondering if something like a kenalog injection would take care of something like this.

Pics in this thread from surgery back in January.

https://www.gynecomastia.org/smf/index.php?topic=22117.0

Discomfort long term after surgery can be from many possible causes. Injured nerves, nerves trapped in scar tissue, and tender tissues from hormonal stimulation are but some of the possibilities.

I have posted extended resources on the possible mechanisms of the Puffy Nipple Complication I have found while revising this problem I have corrected after surgery done elsewhere. Residual gland, scar tissue, new gland, residual fat are among many that I have seen.

Steroid injections can help soften scar, they will not deal with residual gland, newly forming gland, hormonally swollen gland, and not manage an injured nerve. Look for before and after treatment documentation of any recommendations for treatment to best understand what result look like. The standard pictures and videos are powerful tools in evaluating such problems and solutions.

Hope this helps,

Michael Bermant, M.D.