Att: Doctors - I need your opinion. Delgado, Silverman, Pope, Jacobs and others.

[AndreasN]

Hello doctors. I'm in the need of your guidance. I have already spoken with DrBermant but I would very much like your personal opinion also rather than just having one doctor.

As of today its been 41 days since I had a gyno operation involving the removal of both my breast glands and also got a liposuction of my breast. After the operation was done I got a quick look on the result before I got the vest on. I looked so nice. I wore the compression vest for 14 days and after that I got it off and also the stings around my areolas.

After about 1 month I contacted my surgeon telling him I was abit unsure / unhappy about the result. The problem is that I still have puffy nipples once i'm getting sweaty, hot and so on. All in all the surgery has helped me with my puffy nipples in a degree, but its still there. The surgeon told me that there was no fat left under my breast / under my areolas and that he had removed the glands also which is the main cause of gyno / puffy nipples.

He told me that it is "normal" about my areolas.. That I get puffy nipples because of the skin on them? Can this really be true? Please take a look on all the pictures I upload and you can take a look for your self and judge. The first 5 pictures are the day I got the compression vest off.

The ones afterwards are its current state 

The surgeon told me he had done lots of those surgery's before and I also read a lot on him on the internet about people telling he did a good job. The scars from the operation and minimal - so perfectly done there

Please .. What can I do? "Demand" Will or even can he do a new operation free of charge or how does it works? I paid ALOT of money and I cannot afford a new operation.
The healing process has gone very well. Even after 2 weeks I thought it was completely healed up? It has looked the same ever since.

I spoke with a guy here on the board telling me it would be a good idea to wear the compression vest once again for some time since there seems to be an individual opinion on for how long you should wear it? Some people say 2 weeks, 4 weeks and even some say up to 6 weeks? My plan is to wear the compression vest for additional 14 days = 1 month on / off. I hope this will turn out okay in the need

Now... I would very much like your opinions doctors on what you would say is wrong with me giving the information I have provided and the pictures listed below?

A picture says more than a thousand words.

Pictures 14 days after the I got the compression  vest and strings off:

1
2
3
4
5

I LOVE this result. I wished it would stay this way but sadly today ( 08-06-2011 ) it looks like this?

I don't know how to describe my situation I am in? I had both of my glands removed? Liposuction done also? They took 250ml fat from each breast. Its been 42 days since I had surgery so the pictures are all brand new so you can see my how my current situation is.











A guy told me here on the board that it most likely could be the swelling but even though it feels very soft? There is no hard feeling of any kind around my breast. All sofy.

Those god damn puffy nipples... Arghhhh!!

[DrBermant]

Hello doctors. I'm in the need of your guidance. I have already spoken with DrBermant but I would very much like your personal opinion also rather than just having one doctor.

Sir, we have NEVER spoken, you do not have my specific recommendation nor my specific advice. That I reserve for a consultation or a remote discussion. I did post an answer to your request for help here:

Hello everyone. 5 Weeks ago I had a gyno operation involving the removal of both my breast glands and also got a liposuction of my breast. After the operation was done I got a quick look on the result before I got the vest on. I looked so nice. I wore the vest for 14 days and after that I got it off and also the stings around my areolas.

After about 1 month I contacted my surgeon telling him I was abit unsure / unhappy about the result. The problem is that I still have puffy nipples once i'm getting sweaty, hot and so on. All in all the surgery HAS helped me with my puffy nipples in a degree, but its still there. The surgeon told me that there was no fat left under my breast / under my areolas and that he had removed the glands also which is the main cause of gyno / puffy nipples.

He told me that it is "normal" about my areolas.. That I get puffy nipples because of the skin on them? Can this really be true? Please take a look on all the pictures I upload and you can take a look for your self and judge. The first ones are before my surgery and I wish my areola / nipples would stay that way 

The ones after are when its "bad"

The surgeon told me he had done lots of those surgery's before and I also read alot on him on the internet about people telling he did a good job. The scars from the operation and minimal - so perfectly done there

Please .. What can I do? "Demand" he do a new operation free of charge or how does it works? I paid ALOT of money and I cannot afford a new operation.

The healing process has gone very well. Even after 2 weeks I thought it was completely healed up? It has looked the same ever since.



A week after or so it started to look like this

11

I'd wish my nipples would stay the same way as in picture 1,2,3,4 and 5 Those days after the operation I have never been more happy in my life. But the joy was soon over as you can see in the rest of the pictures
Thank you in advance for your help and time.
Best regards - Andreas

Hello DrBermant. I was hoping you could take a look the forum post I have made today. I could really use some guidance on my operation I have had. It's about I still got puffy nipples and abnormal areolas now.
Thank you in advance.

Best Regards

Swelling after some surgery can mask deformity such as what I have described as the Puffy Nipple Complication. That is why I concentrated on minimizing my patients' early swelling and tissue damage, so I could see what I was sculpting and not have such issues. Documenting the progression also has value, but whatever might be there is lost on the sheer number of images without order. (Part of the fault of that is the way this site permits images, which is why I prefer formatting I can achieve on my own pages to show such critical issues. My Standard After Gynecomastia Surgery set can be really revealing, but you are looking for one of each of the pictures featured, the entire set. If there are to be time sequence images, they need to be labeled to demonstrate what time after surgery.

What I never understood is the concept why trust the same surgeon to go back for the revision if they did not have the skills to address the problem the first time. I have seen patients come to me after up to 7 revisions by the same surgeon! Is poorly done surgery for free really any advantage? If a doctor has that type of revision skills, he / she should be able to demonstrate such skills with before and after pictures of revision surgery. Seeing such documentation lessens the gamble unless there was a complication during surgery discussed as part of the operation or recovery. That that can be a different matter as would be a second stage operation. It is my personal philosophy that if banging a head against the wall hurts, do not keep banging the head against the wall.

Hope this helps,

Michael Bermant, M.D.

You then went on to explain that my answer was of little value that you needed specific advice:

Well your answer really didn't help me out that much. I'm a bit lost here to be honest. I don't know how to describe my situation I am in? I had both of my glands removed? Liposuction done also? They took 250ml fat from each breast. Yesteday I actually took some new pictures. Its been 68 days since I had surgery so the pictures are all brand new so you can see my how my current situation is.

I really can't afford a new operation since I have been studying for the past years now. Been saving up / taking loans for this surgery.

Thank you.
Andreas

Your new images again are not the standard set and provide little new details other than the contour does not look good as it should at this time when a minimally traumatic technique is used to manage puffy nipples. The progression of healing seen on my site is typical for my patients and what I expect my surgery to look like as it heals.

Prevention is Better Than Having A Deformity Possibly Needing Revision
I have seen so many unhappy patients from other surgeons operations over the years, I have been trying to help with public education about my findings during revision surgery on these patients. Posts here without links to those resources have very little power of information, but that is the choice of the new forum owner.

I am glad to help you explore your concerns during a consultation or a preliminary remote discussion. That is where I provide my patients specific advice after reviewing information from forums, operative reports, a complete set op images (at least my standard set for Revision Gynecomastia), doctors' office notes, and other critical details. Forum answers must be general in nature. Specific answers on a forum can establish a doctor patient relationship and when the details of the situation are not given are frankly irresponsible. So your expectations for specific help in a forum setting without the details of what happened and other critical issues is simply unrealistic. However, perhaps others are willing to take on the responsibility of providing such specific answers, telling you what to do, and establishing that relationship without those details.

If interested in learning more, Jane is my office manager.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.

Hope this helps,

Michael Bermant, M.D.

That has been the limit of my contact with you other than the private messages, which I reiterated what I posted. You have a generalized non-specific forum discussion of issues. I have not established a doctor patient relationship with you.

Michael Bermant, M.D.

[AndreasN]

DrBermant: What I meant with "spoken" to you is that I already got your opinion on this. Like I said in the subject of this threat the meaning of this is to got other opinions, inputs etc. I would very much like to know what the other doctors in here has to say about it rather than just one. Perhaps some other doctor has another point of view on this.

[Miguel Delgado MD]

Andreas,
Your situation is fairly common, when the compresson garment is remove and you begin with more exertions activities the the swelling sets.  In general, nothing to worry about and just realize it will take time.  I am assuming there is no fluid buildup like a  seroma.
Assuming an adequate removal was done, you could possible get a build up of scar tissue in the area.  Sometimes the areola and the underlining muscle puckers up as a normal response to stimulation.
However at this time patients is  most important.
try not to focus on it for now.

hope this helps

[Litlriki]

I will merely echo Dr. Delgado's reply. You need to be patient.  It is not uncommon to have some swelling of the tissue that is left behind under the nipple, and that may appear nearly as puffy as some milder cases in their pre-operative state.  It can happen on one side or both sides.  I encourage patients to wear their compression for 4 weeks, but I don't know that wearing it longer provides any benefit in most cases.  I also recommend massage to the area.  Some patients form scar under the nipple, and this can cause some hardness and puffiness of the remnant that is left behind.  If that happens, I will consider a cortisone (Kenalog) injection when I see the patient back at six months post-op.  I don't usually do an injection before that. 

Unfortunately, with summer coming up, you may find that the nipple is a little more puffy than you'd hoped for following surgery, but it doesn't mean that you need a revision at this stage--just patience.

Good luck,

Rick Silverman

[AndreasN]

Migueldelgado & Dr. Rick Silverman: Thank you both very much for your answers. It really gives me a little comfort giving my situation here.
I still wear the compression vest. My plan is to wear it for additional 2 weeks and then take it off.

I just pray that the healing process will fix my puffy nipples.

Thank you again.

Andreas

[George Pope, M.D.]

This should be an easy fix.  You need additional tissue removed.  You have to leave enough breast tissue behind the nipple areola to maintain blood flow to the skin, but if there's still a puffy appearance, more tissue should be removed.

Dr. Pope