Is this possible?

[mediator]

Yesterday I had an operation and I only had liposuction. My doctor said that she will do liposuction and if there will be to much glandular tissue she will also do an excision. After surgery, as soon as  I woke up my first question was if I had mostly fat or glandular tissue. The doctor said that she did only lipo because I had also some glandular tissue, but because this tissue was so small and soft she destroyed it and sucked it out with lipo so no excision was needed.

So my question is, if glandular tissue is not very big and strong and firm, instead is small and soft, can it be removed with liposuction only?

 I should  also mention that today, 1 day after surgery when nurse changed the bandages, my chest looked great, although a little swollen but nipples were smaller and chest looked completely flat.

Im also almost sure that I had some glandular tissue because I could feel it under my hand, especially on my left side where nipple was very puffy. So again, can glandular tissue be removed with lipo only as my doctor said to me and although I've seen my chest for a little time, it looked great.

Thanks for help!

Sorry for my English, I know it's not perfect...

[Litlriki]

If there is a substantial amount of glandular tissue which is solid and not mixed with fatty tissue, it's very difficult or impossible to extract that with liposuction.  But if there were just some small areas of fibrous tissue with mostly fat, it might be possible to extract mixed with the liposuction aspirate.  You'll know if it was adequate when the area heals and the swelling resolves.  If it looks good so far, you will hopefully be all set.

Good luck,

Rick Silverman

[DrBermant]

Yesterday I had an operation and I only had liposuction. My doctor said that she will do liposuction and if there will be to much glandular tissue she will also do an excision. After surgery, as soon as  I woke up my first question was if I had mostly fat or glandular tissue. The doctor said that she did only lipo because I had also some glandular tissue, but because this tissue was so small and soft she destroyed it and sucked it out with lipo so no excision was needed.

So my question is, if glandular tissue is not very big and strong and firm, instead is small and soft, can it be removed with liposuction only?

 I should  also mention that today, 1 day after surgery when nurse changed the bandages, my chest looked great, although a little swollen but nipples were smaller and chest looked completely flat.

Im also almost sure that I had some glandular tissue because I could feel it under my hand, especially on my left side where nipple was very puffy. So again, can glandular tissue be removed with lipo only as my doctor said to me and although I've seen my chest for a little time, it looked great.

Thanks for help!

Sorry for my English, I know it's not perfect...

When gland comprises a trivial component of the contour, liposuction alone can be enough to contour the chest. You cannot tell before surgery what is gland vs fat. Although gland tends to be firm and fat soft, fat can be firm and gland soft. Only with the passage of time and an accurate assessment will tell if you have had a successful contouring unless you have a great looking chest with negligible or no swelling. If that has been achieved, as I typically do with my techniques, then you might be able to tell now.

Unfortunately you care correct. Liposuction does not manage gland. I have seen too many unhappy patients done elsewhere to believe that it does. Quite a few of the patients I have seen over the years actually came asking for help after surgery by doctors who had written papers claiming that liposuction managed gland. Now I do not see their success stories, but nor have I seen any documentation in the literature that the gland truly is managed by the liposuction methods. I saw so many such unhappy patients that I coined the term Puffy Nipple Complication after gynecomastia surgery and published what I found during my revision of such cases with examples.

If your contour looks good once swelling goes down with my Standard After Gynecomastia Photo series and even more critically on the Standard Videos, then truly the results have been achieved by liposuction. One of the most common finding has been that the liposuction dug a hole in the fat for the remaining gland to sit in. Unfortunately, gland does not compress like fat. That is why when flexing muscles, lifting arms up over head, the way tissues compress is different. That is why the hallmark of my Dynamic Technique is to target the gland first.

To best understand how your surgeon's techniques evolve after surgery, you will need to find examples of that methods evolution. What you see on my site is typical for my patients but not necessarily other methods. I post such examples so that my patients can feel comfortable and relaxed after surgery about their contour and how they will be evolving. Perhaps other surgeons will similarly adopt similar tools to help with their patients' stress and education.

So if, once swelling resolves, it looks great while enjoying life, playing sports, flexing, and swimming, then excision was not needed. If it only looks good while swollen or only in a few still photos, then you may have become another complication of residual deformity. This should be a contour deformity that is visible, not just something that can be felt. Ideal surgery leaves no scars. That is not realistic. We can endeavor to come close, but I advise my patients that the contour is the main goal. Some scar beautifully, but expecting that is beyond surgeon skill as I know it.

I also have not found a way to document that aspect, how tissue feels, scar quantification, has escaped us despite many years of trying. Perhaps someday someone more cleaver will come up with a method. I have not found it. So for now documenting the dynamic component is as close as I have been able to design.

Hope this helps,

Michael Bermant, M.D.

[mediator]

The day after surgery I was lying on the back when I saw my chest just for a short time and it looked great. Also there was almost no swelling. But then after 6 days when I took my vest off for the first time to take a shower, well I was a bit confused. In standing position my chest looked lets say around 50% better. When I took off my vest both sides became a litle bigger and not symetrical and puffy but hopefully this is just swelling.

Also what it looks strange to me is that swelling started getting worse after 4-5 days instead of 24-72 hours after surgery like I read its most common. Maybe is that so because I think I had my vest on to tight? For the first 2-3 days I had some kind of band around my chest and I think it was to tight. Can this lead to serious problems in healing? Now I have vest design veronique stage 1 and after 15 days post op I'm planning to start wearing vest stage 2.

Here are some of my pictures before surgery, I will try to take some new photos tomorrow 9 days post op.

[mediator]

Here are some new pictures but they are not very good quality cuz they were taken with my phone. When I charge my digital camera tomorrow I will make some better pictures. Now I'm 9 days post op. What do you think how much improvement can I expect when the swelling goes down?

[Litlriki]

Obviously, 9 days is a little early to make a final assessment, but you look okay in these photos.  My advice at this point would be to relax, recover, follow the instructions of your surgeon, and see how things look over the next several months.

RS

[mediator]

Thank you doctors for all the answers and advices! I have one more question for Dr. Bermant, what do you think how many days after surgery should I start wearing compression vest stage 2(design veronique)?


Here are some better photos taken today 10 days post op. How much improvement can I expect because as you can see both sides are still a litlle puffy and I'm not sure if it's because of the swelling or maybe there is still some fat or tu much gland inside. What do you think?

[Dr. Elliot Jacobs]

The results at 10 days post op look pretty good -- and apparently no peri-areolar incision was made.  And at 10 days, you can bet there is still substantial swelling.

Would very strongly recommend calming down, following the instructions of your surgeon and giving it 4-6 months before you begin to make any conclusion about the results of the surgery.  You are now in the time frame when there is nothing to do but be patient.

Dr Jacobs

[DrBermant]

Thank you doctors for all the answers and advices! I have one more question for Dr. Bermant, what do you think how many days after surgery should I start wearing compression vest stage 2(design veronique)?

Here are some better photos taken today 10 days post op. How much improvement can I expect because as you can see both sides are still a litlle puffy and I'm not sure if it's because of the swelling or maybe there is still some fat or tu much gland inside. What do you think?

Thank you for posting the additional pictures. If that was a series of photos for my patent, I would want to better understand why so much bruising and swelling. Compared to what you see on my site, that is quite a bit more. That can be about the right amount of swelling for my much more extensive cases such as my Internal Lift or Male Mastopexy, but those are much more extensive operations. You can also see such evolution on my site to see what I am talking about for those cases too.

That is why to understand the path any surgeon's method takes you from the before to the after, you need to see examples of that doctor's early results. Just how much of that is swelling vs. residual contour issues, only time will tell. That is one of the advantages of attempting to minimize the injury component that can confuse the understanding of the contour, seeing an early result, and lowering anxiety levels of my patients to understand what to typically expect.

I prefer to individualize each of my patients timing for compression garments. So checking what your own surgeon recommends will be the way to go. For my patients, they begin the learning process about what it takes to deal with the second stage garment before the operation when we fit them. After surgery the standard photographs also serve as an education tool. Look carefully an you will see that patients do not lift the arms up overhead as they are listening to their bodies and not trying to strain the healing structures. Such education is part of the method we evolved to have peak swelling in the operating room and continue to improve after that. When you see other doctors' patients posting about swelling starting after surgery and getting worse, that is something I prefer to avoid. More swelling can impair healing, slowing recovery. You certainly cannot get one of those second stage garment on safely until the tissues will take it.

Hope this helps,

Michael Bermant, M.D.

[mediator]

Again, thank you very much for all your opinions doctors, I really appreciate it. Now about the timing for vest stage 2, problem is I'm not from US, I'm from Europe, so my surgeon is not familiar with this kind of vests(design veronique). Here in my country you can not get compression vests, you can only buy binders like one on the picture below. Logically, after surgery I wanted the best for my chest so I ordered vests from US. Unfortunately, my surgeon cannot advice me regarding vests stage 1 and stage 2 because she is not familiar with them and that's why I'm aksing here. I know you can't tell me the excat day when to start wearing vest stage 2, like 15 days after surgery it's time to wear it! I understand that. I'm just asking for approximately time frame when to start wearing it, like from 10-20 days after surgery or 20-30 days after surgery. To point out I had only liposuction and I can easily lift my arms overhead without any pain or discomfort. I'm now 13 days post op.


Here is the picture of the binder my surgeon adviced me to wear, but I bought vests instead.

[Dr. Elliot Jacobs]

There are no hard and fast rules in post-surgical treatment.  It all depends on the extent of the surgery and then, of course, the health and healing powers of the individual patient.  That is why surgeons like to give general guidelines for post op care -- but then individualize those guidelines for each patient.

Your photos at 9 and 13 days look quite good.  I like to keep things simple and uncomplicated.  I do not believe in stage 1 and stage 2 garments -- to me its just an excuse to sell more garments.  I prefer compression with an UnderArmour type of elastic shirt against the skin followed by a binder on top.  The binder is useful because it has variable compression.  In the rare case that it slips down, then a safety pin on each side can hold it up by pinning it to the underlying UnderArmour shirt.  Although some surgeons claim that it can provide too much compression and compromise blood circulation, I have never seen that -- the binder would have to be so tight that you could not breathe. 

Dr Jacobs

[mediator]

Thank you for your answer Dr. Elliot Jacobs. I kind of agree with you. The reason I want to put on vest stage 2 is that simply it seems to me that vest stage 1 just doesn't offer enough compression. Before surgery I was wearing compression vest to hide my chest and I was wearing a vest which I bought on ebay and which offered a lot more compression than vest stage 1 which I'm wearing now.

[Dr. Elliot Jacobs]

That is why I use a binder to deliver the best compression.  A compression vest simply does not supply sufficient compression, IMHO.

Dr Jacobs

[mediator]

First 2 days after surgery I was wearing only binder cuz my vests haven't arrived from US yet. Then when I received vests 2 days after surgery I started wearing vest stage 1+binder. I wore vest+binder for about 4 days and then 6 days post op I started wearing only vest stage 1. I'm now 2 weeks post op and I'm planning to start wearing vest+binder again cuz I feel like vest alone doesn't offer enough compression. Does this make any sense, to start wearing binder again 2 weeks after surgery?

I have one more question, how can I distinguish hematoma from just normal swelling? My left side seems to be more swollen and I can feel something hard and when I touch this it hurts a little. It doesn't feel like a fluid and it doesn't move and it is very hard.  It is located between the nipple and armpit. It is shaped like a rib, on the both ends its thinly and in the middle is a little bigger like a mountain. Is this just stronger swelling or sounds like hematoma? Also, can you get hematoma after liposuction only?

Thank you very much for all the help!

[Dr. Elliot Jacobs]

You can get a hematoma after any type of procedure.

However, looking at your photos, it is highly doubtful that you have a hematoma.  It is not uncommon for there to be some swelling, and many times there may be more swelling on one side than the other.

If you are still unsure, then have it checked out by your surgeon.

Dr Jacobs