Post Op Scar Tissue/ Swelling of Serratus

[Builder748]

Hello all, first time poster here.
I had gyne surgery 4 months ago from a very respected, experienced gyne surgeon. About 1 month post-op I developed puffiness in one of my nipples which I was told was a result of scar tissue. I massaged the area for 2 1/2 months with no changes.

6 weeks ago I received my first small kenalog injection that was administered "deep" to avoid any issues that kenalog can have on the skin. So 6 weeks have passed and nothing has changed. I was pretty much guaranteed that revision surgery wouldn't be necessary as my surgeon stood by the work he did 100% and said he took out the same amount of gland on each side (this was a gland/lipo surgery and the right side looks perfect).

I guess my question is, how has the kenalog injection done absolutely nothing after 6 weeks? Does this mean there is residual gland? I know multiple injections are sometimes necessary as well.

The actual scarring looks great and is barely noticeable. I know the general answer of wait at least 6 months before concern but I feel that at over 4 months post-op I could start asking questions.

Another issue I've had was on the same side with the scar tissue under the nipple, below the pec I've developed a lump that seems to be covering the serratus or rib cage. I bodybuild pretty seriously (no anabolics) and this lump has distorted the contour of the bottom of my pec where it meets the rib cage. I'm at pretty low bodyfat so its definitively noticeable (at least to me). Is this more scar tissue? Was this caused by the lipo? The side with the scar tissue under the nipple and serratus "lump" was slightly bigger than the other pre-op and required more breast tissue removal so maybe more damage was done compared the other side during surgery?

Anyway I'm going to see my surgeon again for possibly another kenalog injection and update but would greatly appreciate any input from the regular surgeons or members of this forum.

Thanks so much.

[Dr. Elliot Jacobs]

Another issue I've had was on the same side with the scar tissue under the nipple, below the pec I've developed a lump that seems to be covering the serratus or rib cage. I bodybuild pretty seriously (no anabolics) and this lump has distorted the contour of the bottom of my pec where it meets the rib cage. I'm at pretty low bodyfat so its definitively noticeable (at least to me). Is this more scar tissue? Was this caused by the lipo? The side with the scar tissue under the nipple and serratus "lump" was slightly bigger than the other pre-op and required more breast tissue removal so maybe more damage was done compared the other side during surgery?

This is something that you will have to take up with your surgeon -- it needs a physical exam in order to diagnose it.

As for the kenalog, yes, it does work over six weeks -- you may need more injections.  It is not unusual for there to be the development of some scar tissue directly beneath the areola -- that is not re-growth of breast tissue, it is scar and is amenable to cortisone injections.  Be patient -- the kenalog may need to be repeated.

Dr Jacobs

[eyooh]

As for the kenalog, yes, it does work over six weeks -- you may need more injections.  It is not unusual for there to be the development of some scar tissue directly beneath the areola -- that is not re-growth of breast tissue, it is scar and is amenable to cortisone injections.  Be patient -- the kenalog may need to be repeated.

Dr Jacobs

How hard is it to get kenalog treatment in other countries?
I live in Norway, and I have to wait 3 years (!) before they'll consider injecting cortisone to reduce the scar tissue.
Is it a complicated procedure? is it costly?

[Dr. Elliot Jacobs]

I do not know why any medication should not be available in your country. 

As for as when to inject, I see no reason why they should make you wait three years for treatment.  If I feel Kenalog is needed, I will inject at 4-6 months after surgery, and in some cases, even sooner.

It is not a complicated procedure -- if you know what you are doing.  As to cost, yes it is an expensive drug -- but the costs for an injection should not be extraordinary -- perhaps a few hundred dollars, which certainly is better than another operation to cut out the scar tissue (and perhaps develop even more scar tissue afterwards).

Dr Jacobs

[eyooh]

Thanks for a very quick answer
The waiting lines for this kind of procedure is incredibly long if you live in Norway. They prioritize people with serious conditions.
Hopefully I can get it done in some privat hospital or something.

[Dr. Elliot Jacobs]

Sorry to hear about the extended wait.  Unfortunately, in a system of socialized medicine, this is not all that unusual.  You might do better trying to get the injection done privately.

Dr Jacobs

[pythose]

Hello all, first time poster here.
I had gyne surgery 4 months ago from a very respected, experienced gyne surgeon. About 1 month post-op I developed puffiness in one of my nipples which I was told was a result of scar tissue. I massaged the area for 2 1/2 months with no changes.

6 weeks ago I received my first small kenalog injection that was administered "deep" to avoid any issues that kenalog can have on the skin. So 6 weeks have passed and nothing has changed. I was pretty much guaranteed that revision surgery wouldn't be necessary as my surgeon stood by the work he did 100% and said he took out the same amount of gland on each side (this was a gland/lipo surgery and the right side looks perfect).

I guess my question is, how has the kenalog injection done absolutely nothing after 6 weeks? Does this mean there is residual gland? I know multiple injections are sometimes necessary as well.

The actual scarring looks great and is barely noticeable. I know the general answer of wait at least 6 months before concern but I feel that at over 4 months post-op I could start asking questions.

Another issue I've had was on the same side with the scar tissue under the nipple, below the pec I've developed a lump that seems to be covering the serratus or rib cage. I bodybuild pretty seriously (no anabolics) and this lump has distorted the contour of the bottom of my pec where it meets the rib cage. I'm at pretty low bodyfat so its definitively noticeable (at least to me). Is this more scar tissue? Was this caused by the lipo? The side with the scar tissue under the nipple and serratus "lump" was slightly bigger than the other pre-op and required more breast tissue removal so maybe more damage was done compared the other side during surgery?

Anyway I'm going to see my surgeon again for possibly another kenalog injection and update but would greatly appreciate any input from the regular surgeons or members of this forum.

Thanks so much.

I can't really say anything about your swelling but I did have serratus swelling after my surgery. After my procedure (excision and lipo) I had the opportunity to schedule massage appointments with a therapist that specialized in scar tissue and rehabilitation. She was very knowledgeable about the muscular system and had worked on numerous gynecomastia patients before me. I had serratus swelling that looked like swelling right below my nipple and extended towards my armpit. The massage therapist told me (after really working on it) that it was indeed cramped muscle. She said for some reason those muscles tighten,contract,cramp in response to chest surgery. Mine persisted for about 2 months. It eventually went away. I'm going on 8 months and still have a little scar tissue around my nipple (not behind/under). I have heard it can take up to a year for scar tissue to subside. Just be patient.