Bottom area of left nipple somewhat puffy? (updated: pics)

[mum4519]

Hey all,
Had gyno surgery one month ago today. Developed a hematoma in my right chest area so the doctor opened up the original incision and "pushed/popped" out all the blood like you would with a zit, and then stitched me back up. Everything on this side looks wonderful now.

On my left side the bottom area of my nipple (where the incision was) is somewhat pushed "away" and out from my chest, making it appear a little puffy. I can feel little scar tissue where the incision was. It's almost as if my PS didn't lipo enough fat underneath my nipple area as he did on the right and this is making it appear the way it is. The bottom part that is being pushed away from my chest and outwards puts somewhat of a crease in the middle of my nipple, like a rippling effect. I could be completely wrong about this all and this is normal and will heal on its own, but for my sake it'd be nice to hear some input on it from anybody with a similar experience, or some doctors who have dealt with this before. I will try and get some pictures posted also asap. Thank you very much.

Before



After....in my opinion, my right side feels and looks absolutely great to me! I can say the same with my other side, it's just that little creasage of what looks like excess fat around the nipple, possible scar tissue? In the 2nd picture in the "after" section, if you look at the bottom of the nipple in the background, you can see it protrudes just a little unlike the other side. Nothing too serious but it bugs me like crazy when I look down at my chest from the top view.

[mum4519]

Does anyone have any input? Thank you.

[DrBermant]

Hey all,
Had gyno surgery one month ago today. Developed a hematoma in my right chest area so the doctor opened up the original incision and "pushed/popped" out all the blood like you would with a zit, and then stitched me back up. Everything on this side looks wonderful now.

On my left side the bottom area of my nipple (where the incision was) is somewhat pushed "away" and out from my chest, making it appear a little puffy. I can feel little scar tissue where the incision was. It's almost as if my PS didn't lipo enough fat underneath my nipple area as he did on the right and this is making it appear the way it is. The bottom part that is being pushed away from my chest and outwards puts somewhat of a crease in the middle of my nipple, like a rippling effect. I could be completely wrong about this all and this is normal and will heal on its own, but for my sake it'd be nice to hear some input on it from anybody with a similar experience, or some doctors who have dealt with this before. I will try and get some pictures posted also asap. Thank you very much.

Hematoma or a collection of blood is in itself an additional injury the body must heal itself from. The body must dissolve the blood and then absorb all of the products. This process extends the recovery process from swelling and bruising. Sometimes the remaining elements become a contributing component for the residual puffy nipple complication I named for the many patients coming to me unhappy with surgery done elsewhere. This contour may yet resolve. When it does not then revision surgery becomes an option. My standard revision gynecomastia pictures methodology was developed to demonstrate and document such issues after surgery. Follow the instructions carefully if you want others to better understand your concerns.

The best way to deal with them is not to have them in the first place. Something that is best approached for a passion to minimize bruising, bleeding, and swelling after surgery. My photographic documentation of my patients' progression of healing after surgery has permitted me to analyze my techniques and evolve them over the years such that hematomas are quite rare in my practice, but they can happen.

Hope this helps,

Michael Bermant, M.D.

[mum4519]

Thank you for your reply Dr. Bermant,

The hematoma itself was on my right chest, whereas the puffy nipple is on my left side. My right side (where the hematoma was) looks amazing, couldn't ask for a better outcome as to this point. Whereas the bottom of my left nipple protrudes just a slight bit. It is almost as if there wasn't enough fat removed during the liposuction, and there is a little excess fat directly beneath my left aerola and for some reason it is protruding. Is this common? My surgeon has excellent credentials, and either way did a wonderful job for me from what I was before. For some reason this just nags at me. I can feel scar tissue where the incision was. Is it possible, or probable, that when the scar tissue starts going away that the skin will pull a little tighter?

Dr. Bermant?

Dr. Jacobs?

Anyone?

Thank you so much!

[Dr. Elliot Jacobs]

Difficult to comment based upon your description -- but it is only one month and your tissues are still in the very active healing phase.  there may be just swelling and/or scar tissue at the site of the incision.

If you can post a photos, it would be helpful.

In any case, at this point, patience is paramount.  A visit to your surgeon could also allay many of your concerns.  Fortunately, in plastic surgery, if scars do not heal quite well, we have another opportunity in the future -- it is called scar revision (a minor surgical procedure).  However, more than likely, your situation will settle down over time.

Glad the hematoma situation was dealt with appropriately.

Dr Jacobs

[DrBermant]

Thank you for your reply Dr. Bermant,

The hematoma itself was on my right chest, whereas the puffy nipple is on my left side. My right side (where the hematoma was) looks amazing, couldn't ask for a better outcome as to this point. Whereas the bottom of my left nipple protrudes just a slight bit. It is almost as if there wasn't enough fat removed during the liposuction, and there is a little excess fat directly beneath my left aerola and for some reason it is protruding. Is this common? My surgeon has excellent credentials, and either way did a wonderful job for me from what I was before. For some reason this just nags at me. I can feel scar tissue where the incision was. Is it possible, or probable, that when the scar tissue starts going away that the skin will pull a little tighter?

Dr. Bermant?

Dr. Jacobs?

Anyone?

Thank you so much!

I have seen many different factors for contour problems after surgery.

The Standard After Gynecomastia Surgery pictures I evolved are a fine way to demonstrate how good your result on one side is and contour issues on the side you are concerned about. The multiple angles, flexing, and arms up overhead can really show off the quality or deficiencies of any particular technique. As I answered above, I do see many so many patients unhappy with contour problems after surgery done elsewhere. So it is quite common in my practice, but I do perform a great deal of Revision Gynecomastia Surgery. Yet, it is very rare for me to perform revision surgery on my own patients. Just how common the deformity is for other surgeons is impossible to predict. Happy patients tend to not complain. Not all surgeons document refined issues with the different angle views, flexing, and videos. I have had patients come to me with just horrible results who claim that their doctor said that the result "looked great."  I have published several such examples demonstrating the issues and revisions I then performed or why I could not fix that problem.

So in my opinion good contours are there only if they can be shown to be there. Evaluating how results look while living life is an important issue. It is not sufficient for me to have a few views to show "the result." Hand waving with words is not good enough for an evaluation of any surgical sculpture.

You have had cuts before. Tissues to tend to evolve after injury such as surgery. Firmness and loose skin change. We have no decent method to calibrate just how elastic the tissue is before or after any tightening procedure. By targeting gland first, I see the biggest change for loose skin on the operating table. Then there are slow less obvious changes that occur in the next several weeks. Change is even more subtle for longer time periods. That is the value of interval documentation as I have published on my site. Loose skin is very difficult to document with pictures. For this collection, look for the wrinkles in the contour. The bending over views can show gross issues when gravity can pull the excess away from the body. The videos do a little better job with the flexing muscle and arms up overhead series. Look for the bouncing and jiggling of tissues on the videos.

Hope this helps,

Michael Bermant, M.D.

[mum4519]

Updated, with pics.

About 5.5 weeks post-op.

[Litlriki]

The photos are helpful, and I'd tell you to wait for continued progress.  Small contour issues are not that uncommon, especially in someone who has a more extensive procedure involving a significant amount of liposuction as well as glandular excision.  Slight asymmetries this early, as well as small dimpled areas or puffy areas (especially in the face of a hematoma) require more time for complete resolution.  It sounds like your hematoma was managed properly, and your results as compared to your pre-operative photos are reasonable for this stage.  It looks like you had some asymmetry beforehand, and you may still have some asymmetry after the surgery.  It looks like you're headed in the right direction though...

Good luck,

Rick Silverman