Post surgery issue. Docs and all.

[Cale]

So might as well tell my story. Like a lot of others, I've read heaps here but never felt I had much to contribute, until there's a problem...

I'm 24 now and have had Gynecomastia since I was a young teen. I smoked a whole lot of weed when I was super young, from before I was even 12 till about the age of nearly 16, when I gave it up and haven't touched since. I went from being a fit and thin little kid to a fat little stoner, partly I believe may have been the weed playing havoc with my metabolism maybe, through a change to the hormones. Maybe, I don't know. But I did end up with the puffy nipples which I hated, and when at the age of about 20 I hit the fitness routine and got into shape, it was definite I had Gyne, clear as day. So just this year after working and saving a whole bunch l planned out a bit of a world trip and thought why not include America where I can have the surgery while I'm there. Timed it about halfway through, which left me enough time in the states to hang around for a couple months after. 

Anyway I went with the doctor who's been removed from this site, the one from NY. I figured he's done enough of these surgerys on similar bodied people (just gland excision, no lipo) that it kinda speaks for itself. So I paid top dollar, had the surgery done etc which was all good itself. 

Afterwards, when I was wrapped up and shown the glands removed, this is where things got me worried. I should point out that my case was asymmetric before the procedure, not crazily like some cases, but somewhat noticeable if you looked at me normally standing there, and very noticeable to feel. This of course I made sure to tell him, even though it was clear. So back to viewing the glands removed, I was very shocked to see the glands an almost identical size, to my eye anyway. I got pretty familiar with my Gyne, including the difference in size between the sides,  as all of you living with it for ten years would know. You tend to feel it daily! Pretty much I had trouble pointing out which one was from the larger right hand side. I did manage to just pick it and kinda mumbled that it was barely larger than the other which didn't really get a response. My fault for not really speaking out loud  there and then! But was already stitched  and wrapped up anyway. 

So the five days go past all good, other than me being worried about there being gland left behind. Get the compression bandage off and was delighted to see the left side was completely flat, while the right side not as much, still slightly puffy, visible to the eye if you looked anyway. About the same difference between the sides as before the surgery. Pretty much what I had I expected (feared), going by the lack of visible difference between the two glands removed in comparison to the difference I could feel before the surgery. 

After sitting round the hotel with all the time in the world to ponder the still slightly puffy side I went back in to see him two days later. Now I am aware, and have read many stories on here, that swelling and scar tissue can form asymmetrically etc, even as early as the initial unwrapping of the bandage however many days after. If my case were one of even sides with the same amount removed, or even uneven sides with the amounts removed reflecting that difference I wouldn't have been inclined to wait it out like normal. But that lack of visible difference was too much for me. 

Back in the clinic got more frustrating. He pretty much brushed me off completely. That's just swelling etc, which he drained a small amount with a syringe, which I dont really think was even necessary, more to get me at bay and out of the clinic. And of course it did nothing for the puffiness which was still the same. Back to waiting till the ten day mark appointment. Of course I was out to voice my concerns again. This time was even worse. Drained a small amount again to try quell me. But after I pushed more was given 'Don't do this to yourself, you're a good guy'. ' I took everything except the muscle. I don't wanna hurt you' et c. As well as 'No one is symmetrical'. 'None of my patients in the gallery are completely the same'. Which def pissed me off as I got the idea that he would be happy with that level of asymmetry, final product or otherwise. Def not the perfectionist I had thought.  I questioned if he had the gland weights back yet (as I figured to myself might help me calculate just how much was removed) he just kinda trailed off that he didn't have them. 

So that was pretty much that. I felt completely brushed off. Honestly, I think he just hoped I would be heading back to Australia and the problem would disappear. I decided to send a formal email to him better addressing my worries as I just couldn't get through in person. In the end I never received a personal email back, just a brief reply typed up by the secretary about how soon  it is to be judging results. The one thing she did send through were the weights of the glands removed, according to pathology. I haven't seen a copy of the report yet but she stated to me that 7.5 grams had been removed from the left, while 10.2 had been taken from the right. This really surprised me as there didn't appear to be that much of a difference in size when I got the quick initial look? Also gave me some hope that maybe he had taken more than I thought and it was mostly irregular swelling or scar on one side. 

Fast forward two months and nothing has changed. My left side is still flat, albeit a tiny bit raised along the excision site as was present from the unveiling. Bit of an average scar, but pretty damn good really. Right side is the same too. Better actual scar than the left side, but still the same as the day I first saw it. Too puffy. Now I have been routinely massaging and all, but I'm almost positive scar tissue is not the problem. It's hard to explain but for those of you who've had the procedure and are in a similar boat you might understand. Basically both my sides have scar tissue, very little though. And it's kinda funny they've both developed the same, symmetry wise. I can feel it kinda goes from behind the nipple and slightly extends from the top inside 'corner' of my nipple to my chest. While the outside and outside corner have none. When you feel both, squeezing sidewards and lengthwise top to bottom they feel the same size and shape. The only difference on the more puffy side is the depth. The whole general area is bit more raised, with that same contour I previously had, only less so of course. Which I put down to remaining gland. Now the real kicker for me is separate to the scar tissue, when I press on the nipple and especially the outside part which is empty of scar tissue, I'm able to feel what feels like the old gland I had before. The flat left side has the tiniest bit there, perfect amount to save sunken nipple, but the right side has enough to give the same feeling when I run my fingers over it as it did before surgery. Again less so though. Before surgery I used to put my index finger and middle finger sideways over the nipple and alternate pushing each, making the gland almost 'click' when it shifted from side to side. Now when doing that, I can feel the exact same movement, from underneath the scar tissue. And under the outer side of the nipple I can clearly feel hard gland. Sorry if I've strayed a bit, it's hard to explain.

So anyway brings me back to the question of mine previously posted about tissue density. I'm just not convinced the weight difference reflects the size of the gland I saw dimensions wise. Maybe it's possible the gland on my right side was more dense? While it always felt larger, thinking back on it now, it also possibly felt harder too, which may explain the extra weight of it, the density. I'm not sure, but either way I believe not enough was taking out, I can just feel it. From seeing the gland removed, to the unwrapping, to now 2 months later, nothing has changed. 

I have booked an appointment for Monday, as I'm booked to leave the country from the West Coast in a couple weeks. I'm really wondering what he's gonna have to say. Whether he pulls the same story of 'I removed everything except the muscle', which of course isn't entirely true anyway, even with my flat left side some was left to support. Then if he claims it as swelling and scar tissue, there's the issue of having to come back and have Kenalog shots, which again worries me as injecting the stuff into something that isn't scar tissue is dangerous in itself? And if it is deemed to be left behind gland there's the pain of having to come out to the US again and have a second surgery, as even though I'm still here, 2 months is a bit soon. I don't see him admitting to leaving behind too much in any case. Either way it's a pain in the ass that I certainly didn't expect this happening to me, not from such an experienced surgeon and supposed sculptor. 

Sorry if I've rambled on too much, or strayed from the point. I really wish I could just be patient like it was any normal story, but the whole lack of visible size difference has had me from day one.

Also when I get on a computer next I  can post a picture of me pre surgery, bending forward and showing the asymmetry.

Anyway, feedback, Q's or A's would be awesome. I will also reply with how the appointment went.

[Dr. Elliot Jacobs]

Thanks for your story -- sorry for how you have ended up.

To specifically answer your question, tissue density is usually the same on both sides.  The weight differences of tissue is usually due to the difference in volume of tissue removed.

I think the key to your situation is that there was visible a difference in the result so soon after surgery.  This is sometimes explained by fluid accumulation -- but that apparently was drained.  Swelling could also provide a difference -- but swelling is usually more uniform across the chest -- not just at the nipple itself.

In sum, it is possible that your original assumption is correct.  Of course, if revision is considered, it is best to give it at least six months or so -- so two months out is too early to consider it.

Good luck!

Dr Jacobs

[Cale]

Thanks for the reply Dr Jacobs.

I had figured that usually the weight difference laid in the volume, but in the odd case do you think technically it could be possible that one sides extra density made up some of the weight difference? I'm not sure it's even that relevant anymore anyway, but still interested.

I had actually considered having an appointment scheduled with yourself while I'm still in the states, just to get another experts opinion. It's certainly not bad the difference, like people would have to be looking to notice it. Some would prob say best to leave it, but at the same time that same feeling of having Gynecomastia is still just there, even if it is so slight, and will bug me forever.

I any case it's a real pain and one I'm honestly surprised such an experienced doctor could make. I guess nobody's perfect! Everyone makes mistakes. It's how they fix them that counts. We'll see.

[Cale]

Sorry for the late response, I had the appointment a couple weeks ago. I'll say it went through two very two different stages.

The first was just like the last two times. He was incredibly defensive to the point where it instantly became heated. Like the first two times I couldn't just take his word and wait, I had to apply my legit views, and make sure they were heard. Or face going back to Australia knowing I'm fucked. So it pretty much became a verbal dispute. Voices were raised, and I'm sure if there had of been other patients in waiting they almost might've been scared off haha. I will say I'm more mellow than most, and avoid physical confrontation extremely well, but if there's one thing that gets me, it's frustration. It started up so quickly I felt my fists were just about ready to start clinching. Pretty obvious it's absolutely what an appointment between a doctor and patient should NOT be like!

But anyway the appointment started by myself letting him know how disappointed I was in having not received a personal reply email from him answering any of my questions, just the scripted response from the secretary. To which he pretty much didn't have anything to say, just kinda tried saying he didn't have time to write a personal detailed response or something like that. No real explanation.

I then moved to the same initial concern. This is where things started to turn ugly. I tried to discuss the lack of size difference between the two glands removed, again he tried shut me down, even though this time there was no 'swelling' to blame it on. He made sure to repeatedly point out the weights of the gland removed, proving that he did take out the correct amounts corresponding to the initial asymmetry. This is when I got to see for the first time that the report also included length, width and depth measurements of both glands removed. Here's a copy of the report:

'A. The specimen is received in formalin and labeled left gynecomastia. It consists of three, yellow-tan, lobulated portions of fibroadipose tissue weighing 7.5g and measuring 3.7 x 2.8 x 1.5 cm in aggregrate. The specimen is serially sectioned to reveal white-tan, dense fibrous tissue (approximately 80%) admixed with yellow-tan, lobulated adipose tissue. Representative sections are submitted in three cassettes.

B. The specimen is received in formalin and labeled right gynecomastia. It consists of a yellow-tan, lobulated portion of fibroadipose tissue weighing 10.2g and measuring 3.4 x 3.1 x 1.9 cm. The tissue is inked. The specimen is serially sectioned to reveal white-tan, dense fibrous tissue (approximately 90%) admixed with yellow-tan, lobulated adipose tissue. Representative sections are submitted in three cassettes.'

So my initial thoughts of the lack of size difference were shown here. He was quick note that the weight is what you go by, as the measurements can be inaccurate, and of course the shape irregular. I questioned whether density could play a part. He just laughed and gave it absolutely no chance. I did do some calculations however, and while the glands are irregular shaped and certainly no rectangular prisms, if they were, going by the measurements their volumes would be roughly 15.5 and 20cm respectively, which is pretty damn close in comparison to their weights. Also noting the left side was roughly 80% gland, while the right was 90% made my theory of density even less likely. I thought this was all a bit irrelevant anyway. You don't really need a formula to prove it when you can clearly feel it.

So anyhow, it managed to cool down to a more conversational level. This was the second stage. I mentioned the forum about others experiences with asymmetry right after surgery and while he pretty much disregarded it as a 'bunch of people who know nothing' it seemed this was a turning point in his attitude towards my problem. Maybe he was worried I would blatantly start flaming him online? I'm not sure. But it seemed he became a touch more communicative from that point on. He still never admitted fault in such words, and was very lacking in info or answers, but he said he could see the asymmetry and would do revision for free etc to do 'whatever makes me happy'. Again I'm not sure if this was because he was worried I would flame him online, or if he knew he was wrong. I suspect a bit of both, but it's hard to say because he then said out of nowhere let me give you some Kenalog. Which implies he still thought he took enough out and it was a matter of scar tissue, not residual gland. Either that or he was hoping it would satisfy me and have me out of there. Being only two months out and clearly scar tissue not the real problem I of course declined. 

Another couple issues I brought up with him that gained little response or explanation were the incisions. The right side (the one with too much gland) had a super clean and neat incision perfectly following the bottom of the areola while the flat left side had a somewhat slightly irregular incision situated a bit more up the side of the areola, which kinda    wasn't so straight, and edged into the areola itself a tiny bit. I feel this being more on the side of the areola has led to the scar forming and pulling sideways on the areola, causing some slight distortion in shape, and a small crease at the base which has also caused slight pigment loss at the base too. The right side with the perfectly clean incision has none of these issues. These really are quite minor, and will  hopefully go away as the scar at the incision site settles down, but I feel he could've been a touch more careful following the marked line when making the incision. He had no response as to why the left wasn't neat like the right.

This last one I believe is a real rookie mistake and shows how quick he was to get rid of me in the first place. He never removed the stitches. I was assuming they were dissolvable as you could barely see any. But a few weeks after, little threads were popping through the surface. I had a light pull at one and a fine fishing line like thread came out, something that didn't look like it was gonna dissolve. For the most part they just came out with little effort. I thought I had them all until at the bottom of my left sides (already slightly irregular) incision, the scab was still there some time later and almost growing in size compared the the rest of the incisions scab, which was narrow and had already fallen off. I had a slight probe at it with the tweezers and it came away easy, but revealed a stitch I had missed which appeared somewhat ingrown, like the incision had tried healing around but had left it slightly unhealed and open. This one took a tiny bit of effort to pull out, and after wards a band aid held the edges together which were 'fused' the next day. This has definitely led to a wider and more visible scar at the part of the incision, and possibly contributed to the problem above, creating that tiny bit more scar tissue and possibly pulling more sideways. I almost forgot to ask him about this and when I did he kind've looked a bit startled by it but then said he used dissolvable stitches and that the little threads popping up were just 'spitting'. Now when I said but they were like little fishing lines, he just again didn't have much to say. I could be wrong, but I highly doubt those things were dissolving. They had definitely created more problems. I think it was just another case of being careless. Any Doctors feel free to weigh in on this one. Again, I could be wrong.

Of course all the while his talk of being the best and most experienced was jammed in at every opportunity, between stories of how much worse it could've been, with stories of other surgeons botch jobs coming to him disfigured etc. A bit late for those I thought. No point telling me how good you are after you've made an error?

I must say I feel his passion for the work is not there. When I was unwrapped, he didn't even inspect me. He just said 'Wow!' like he'd done Gods work and transformed me, then pretty much walked out. I feel a surgeon with pride in their work would have at least had a look over for an initial critique. He was never very informative or detailed with any info regarding my questions. Maybe I expected too much wisdom for my 7k? I feel I've got a lot more useful info off the 'bunch of people who know nothing' here, free of charge. 

Now I will admit though, if the results had've been up to scratch, it's very likely you wouldn't have had me here saying I went to the wrong surgeon etc.

But in summary, I have to travel back to New York next year to have him correct it. I don't think I can live with it.

Some might say I'd be crazy to go back, especially when it's gonna cost me a fuckload, but of course when you've already paid 7k... And his technique does generally yield quality results. I had very little bruising or swelling, and what it looked straight after unwrapping the bandages, it has kept till this day.  Might help my body didn't develop excess scar tissue. I think it was just that slight lapse in judgement or concentration that was my undoing. 

Sorry if I've repeated myself. If I've rambled too much. If there's no real structure etc. I'm not the greatest writer.

And if this remaining tissue miraculously disappears or even slightly decreases at any stage before having to go back for revision, I will be sure to let you all know that I was wrong!

[Cale]

I should also add that I never wore a compression vest. This is no longer part of his follow up care. Not with gland only removal anyway. He found over the time to have little to no effect in his final results so stopped using them on his patients. I only found this out at the last minute after payment and all and it really had me really worried. But I followed his method and the results and contour are the same now as they were on day one. I was super careful with my movements though and did no running till after 6 weeks or more even, and only just did some pushups for the first time the other day.

Maybe the left areolas scar and slight distortion may have formed a little better with a months compression, but who knows? I don't believe wearing one would have had any impact on more asymmetry though.

[transformSoon]

Can you post  your pre and post pictures. I think it will be easier to visualize the problem that way. It is such a shame that all this effort resulting in dissappointment, however 2 months is still early time to judge your results. If you read on forums people being disappointed for 3 months and then gradually over a year post surgery things become perfect. Not saying that assymetry will disappear but maybe it will not be as noticeable as it is now since you are still in early stage of healing.

[Cale]

I have really clear pre op pics, but they were actually taken a few months before the operation, when I was going through the online examination stage. I've been traveling since then, and as always without being on my exercise routine I've put on a few kilos. I'm just about to return home though so in about 6 weeks when I'm back into the swing of things I should be able to take and post some more accurate after photos. You prob get a reasonable idea from my description for now though?

And yeah cheers for the optimism. I've read I think every post surgery story on this forum. Most seem to develop their asymmetry in the following weeks as scar tissue forms. These stories often sort themselves out, or get Kenalog to help. I have also found a few that, like me, came out asymmetric straight from being unwrapped. Including some that were symmetric beforehand. I haven't managed to find many of these stories with an ending though? And yes time may help, but I doubt very much. Most people seem to be confused afterwards and start posting questions about what is gland and what is scar. While in my case, I'm 100% sure I can distinguish the gland from the scar, just by feel. The puffy right hand sides scar tissue may be ever so slightly bigger than the lefts, up in the top inside corner mainly, if at all. That much is hard to tell. But the remaining gland I feel is definitely more in volume, no doubt whatsoever. That and I like I mentioned many times, I could just tell he hadn't taken out enough by visual. That's how familiar I was with the size difference of my Gynecomastia. Feeling it numerous times a day for 10 years does that.

Still, as you said, a miracle could happen!

[Cale]

Hey all, my follow up and revision story so far can be found in the revision forum.

Thanks.