Pre-surgery worries to post-op concerns: Let me calm your fears!

[hypo123]

  Hello fellow brothers!  Let me start by saying that this post is probably going to be very long and will cover, in detail, everything that I went through and everything that I learned about Gynecomastia during the last 10 months.  For some it will be too long to bother reading, but if you are like I was you are looking for something to help calm your fears and someone to let you know that most likely everything is going to be alright in the end, especially if you are a few weeks post-op and are dealing with swelling and returning puffiness.  I will write headings in bold and underline them so that if, for example, you only wanted to know about post-op issues you could skip ahead to that section.

This is a post that I always promised myself I would write.  The problem with forums like this is that once people have their operations, most of them don't come back because they are happy with their results.  This leaves people hanging and I know it left me with a lot of questions that went unanswered, especially post-op.  

I wasn't exactly sure which forum to post this in as I will be covering a lot of topics which span multiple sub-forums.  This seemed to be the most active section and I hope that the mods will leave it here so that it can potentially benefit the most people.

I had my surgery back in April and am currently 8 months post-op, but we will get to that later.  First, a very brief background on myself and my gynecomastia:

BACK STORY

Like many people, I developed Gyno right around the time I was going through puberty (i'm currently 24).  My gynco manifested as "puffy nipples".  I had hard lumps under each nipple (actually areola is the proper term), which never went away.  I have never been overweight and did not have much fat or a more breast-like appearance.  My body looked fine apart from two huge protruding nipples.  My right side was substantially bigger and more puffy than my left side, and let me just clarify that mine stuck out very far.  I have seen pictures of people who got surgery done and have asked myself why they would even consider it with such a mild case, but to each their own.

I pretty much had the stereotypical experience:  I hated going to the beach, did not feel comfortable taking my shirt off anywhere, would pinch my nipples to make them hard if I absolutely had to take my shirt off, would make excuses to get out of being in situations where my gyno might be seen, would wear an undershirt in an attempt to minimize the appearance of them poking through my shirt, etc.  Basically in a nut shell they really bothered me and played a major role in my self-esteem.  

PRE-SURGERY

I always knew that surgery was something that could be done but never truly considered in until around last february, almost a year ago.  I knew surgery was expensive and I do not come from a well off family who could afford to take on the expense.  If I wanted to do this, it was something I had to fund.  At this point I had been living at home for 9 months or so and had saved up a decent chunk of cash.  It was enough money to do a lot of other things with my life like get my own place, take a trip to anywhere in the world, buy all of the musical equipment I could ask for, etc.  But I told myself I could always do those things later on.  I wanted to fix this problem that had been bothering me every single day for years.

I started doing some serious research and found out that I lived pretty close to many of the top gyno surgeons in the country (I live in the northeast united states).  I knew that I could have gotten this surgery done for much cheaper, but when it comes to gynecomastia, your surgeon's experience level is EVERYTHING!  I have seen stories of people who paid top dollar for some of the best plastic surgeons in the country and had to get revisions done.  Just because a plastic surgeon may be an expert in breast implants or nose jobs, does not mean that they know a thing about gyno.  THE EXTRA MONEY YOU WILL PAY TO SEE A PROPER SURGEON IS ABSOLUTELY WORTH IT! There are probably only a dozen doctors or so that I would have even considered letting touch my chest.

Anyway, since consultations cost money, I didn't have the option to shop around and meet different surgeons.  I did as much research beforehand as I could and made and appointment with a surgeon in New York.  The consultation was pretty brief, but not rushed, and by the end of it I felt comfortable enough to schedule a surgery.  These top surgeons are experts and don't need to sit there for hours studying your chest to see what needs to be done.  My surgeon looked at my chest briefly, did a quick examination (pinching the glands, etc) and answered any questions that I had.  It didn't last more than 30 minutes, and I didn't feel rushed at all.  I had done my research on this guy and knew that he knew his stuff.  

I had a full 5 weeks to wait until I could get my surgery, and during this time I made an effort to get in the best shape that I could.  I started working out every other day with the idea in my head that my body would handle the surgery best if I was in good shape.  I definitely believe that this has some truth to it, and if you are very overweight and out of shape, I would highly suggest that you take a few months to get yourself in shape before even considering surgery.  I don't mean to be insensitive, but I have seen some pictures on here where I questioned why the person would have gotten the surgery done when they were incredibly overweight and out of shape.  I truly believe that you will be happiest with your results if you get yourself into shape beforehand, not after.

I had arranged to take 2 weeks off of work for surgery and told them that I had to get a hernia operation.  I took a full 2 weeks off because my job was physically demanding.  If you sit at a computer all day, a few days off might be fine.  Talk to your surgeon regarding this.

[hypo123]

SURGERY DAY

Finally the day had come for me to get my operation done.  I was excited, nervous, scared, worried, and happy all at once.  The best thing you can do for your body and mind is clear all of your thoughts away with deep breathing.  You are going to be nervous no matter what, but you need to relax and not work yourself into a fit of anxiety.  As far as surgeries go, this is a very minor procedure.

My doctor had a small operating room right in his office, which was comforting because I had already been to his office and it was a familiar place.  I remember laying on the operating table with my shirt off prior to surgery and feeling slightly cold.  I was shaky and nervous, and the only thing that calmed me down was taking really deep breaths and focusing on nothing except for my breathing.  Eventually the shaking subsided and my surgeon started the first of a series of local anesthetic injections.

If you're debating whether to get local anesthesia, twilight, or full, I would personally recommend getting local.  For one, the local anesthesia costs less which is a big plus, but the absolute biggest reason is that your surgery will be a much bigger deal if you are put under.  It requires an anesthesiologist to be there, and a long wait in the recovery room as you come to.  Some people have bad reactions to being put under, and some people have even died from it.  For open heart surgery there is no question that you would be put under, for something minor like this I highly suggest you get local.

What local anesthesia involves is injections around your nipple area.  The doctor made a bunch of marks to form a circle around my whole "breast" area, with smaller circles in between them, and would slowly give me injections to numb the area.  My surgeon did it multiple times and each time went deeper and deeper. After completing a full circle he would leave the room for 5-10 minutes and allow it to kick in before going deeper.  THIS IS THE MOST PAINFUL PART OF THE ENTIRE SURGERY.  And the pain is mild at best.  It sucks getting a needle put into you repeatedly, but the pain gets less and less as the anesthesia kicks in.  By the time he made his last injection (directly into the gynecomastia gland) I couldn't feel a thing.

After this moment you literally don't feel anything.  You get a sort of pulling sensation as they take the gland out and can feel fluid dripping down the side of your ribs when they make the initial incision, but none of it is painful.  My surgeon had an assistant present and they were both very nice and helpful throughout the procedure.  He would tell me what stage he was at and had no problem answering my questions such as "what the hell is that clicking static noise?" "Don't worry, it's a completely normal tool to help stop bleeding before we stitch your incision back up".

All in all, the anxiety and worry before the surgery was 1000 times worse than the surgery itself.  My whole procedure lasted less than 2 hours, and when he was finished, I was instructed to sit up while he wrapped a compression dressing around my chest.  

After that I literally walked back out into the waiting room to see my mom who was shocked at how quickly it went and how fine I looked, commenting that it did not even look like I had any sort of surgery.  I was instructed to sit for around 45 minutes or so and drink some fluids.  

3 hours after entering my doctors office, I was finished and on my way home.

Let me also note that my surgeon did excision ONLY with NO liposuction.  I hear liposuction might have a little bit more pain involved, but I wouldn't know.  

POST-OP

Ok, here we go.  This is the section that I hope will benefit the most people because for me it was the hardest part of this whole process.

You get your surgery done and think, "great, it's all downhill from here!".  Let me just tell you that your battle has only begun.  The most difficult times are ahead.

I say this not to scare you, but to prepare you.  There was a serious lack of information regarding what happens in the days, weeks, and months after your operation.

The first 5 days after surgery were the toughest only because of the compression wrap that the surgeon had put on.  It was tight and whatever the adhesive part of the bandage was made out of (latex I think), caused me to have a slight allergic reaction.  I was incredibly itchy for the entire time and had really red irritated skin all around my sides and back.  Most of you won't have a problem with this, but for me the constant itchiness and slight burning sucked.  It was a relief when I got to go back to the surgeon and take it off.  During this 5 day period I felt only slight discomfort otherwise.  Pretty much just a soreness that felt like the day after a good chest workout.

I went back to my surgeon to have the dressing removed and was nervous to see what everything would look like.  I was scared to look down and asked him how it looked.  He said "see for yourself" in a cheerful tone.  To my surprise everything looked really good!  There was some bruising and I couldn't see the incision line because there were little bandages still on them, but overall I couldn't believe it.  Everything looked wonderful.  My contour was amazing and there was minimal swelling.  I had spoken to him prior to surgery regarding the use of a compression vest.  I had read that some people wore those things religiously for up to 6 weeks.  When I mentioned this, my surgeon actually chuckled and told me it was overkill.  He told me that through over 15 years of experience and 1000's of surgeries he had found that after the first 5 days it made no difference.  Regardless, every surgeon uses a slightly different technique and it's best to listen to yours regarding a compression vest.  The only thing I did buy was a very tight under armor sleeveless shirt.  This wasn't even my surgeon's idea, I just personally felt more comfortable with it as my chest felt kind of vulnerable.

[hypo123]

SWELLING AND SCAR TISSUE

I had read that some people had experience swelling and scar tissue build up very soon after their surgeries, and thought that I was going to be one of the lucky ones to escape it.  After all, I was 10 days out and everything still looked excellent.  Boy was I wrong!

2 days later, right before my 2 week post op visit, I started to develop small lumps right along my incision line (on the inside) which were sore to the touch.  I asked my doc about it and he said it was either swelling or scar tissue and that I needed to be patient.  At this point he took the bandages off of the incision site.  Everything looked good but it was still scabbed over with some other dried blood in the area.

In the coming weeks, EVERYTHING GOT WORSE!  Those little lumps had turned bean sized and my areolas puffed up dramatically.  This was disheartening and incredibly upsetting.  I spent hours and hours reading this board and other sources trying to comfort myself.  Some people assured others that this would subside, but there was a total lack of detailed information from someone who had fully recovered.  Mostly all of the threads were other frantic people who were 3,4,5 weeks, even a few months, post-op that were freaking out about the returning puffiness.  From what I read, and what I came to know was true in my case, is that these half circle lumps in the inside of my incision line were actually scar tissue forming, not swelling, and certainly not gland accidentally left by the surgeon.

Oddly enough my left nipple (which was smaller to begin with pre-op) puffed out to as big, if not bigger, than it was before my surgery.  My right nipple puffed out a lot as well and I had a small crease develop over my actual "nipple" (i've sort of been using the word "nipple" in place of areola.  Areola is the entire dark circle while the nipple is technically the little part that sticks out in the center).  

At my 1 month post op my surgeon again insured me that this was normal.  I started wondering if it was because I hadn't worn a compression vest but then realized that everyone else complaining of the exact same thing had been wearing one.

The scariest part for me was when my scabs along the incision line peeled off.  I looked in the mirror and to my horror there were white spots that extended upwards off of the incision like (where some dried blood had been).  The incisions themselves looked fine but literally the lower 1/3rd of my areola was a very pale color in comparison to the top half.  That's actually how I got my name on here "hypo123".  I wanted to ask the docs on here about the "hypo-pigmentation" that I was experiencing to get more input.  It was explained to me that sometimes it can occur due to a temporary loss of blood flow to the incision site during surgery.  I was told that rubbing cocoa butter on it may help but that it could take months to return to normal.

Great, not only was my contour completely ruined by the scar tissue, but the lower part of my areola was a light pink-nearly white color.  

I became completely depressed about the whole situation.  I had spent $7000 on this and thought I had completely wasted my money.  I tried to read more and more to calm myself down but it didn't help.  There seemed to be a lot of horror stories on this board and I thought for sure that I was one of them. I decided to not come onto this website or read ANYTHING regarding gynecomastia.  I stopped looking in the mirror every 5 seconds and let my body do the healing it needed to do.

Let me side-track here to mention the reason that so many people have horror stories:  They didn't go to an experienced surgeon!  My surgeon told me that 1/3 of all his procedures are revisions!  1/3!!!  That is a huge number of people who made the mistake of going to someone who has no idea how to deal with gynecomastia.  We are talking about things like taking too much gland out, leaving too much in, making TERRIBLE incision choices (like cutting horizontally as opposed to a semi circular incision along the bottom of your areola), using lipo-only without excising any gland, etc.

Like I said earlier, save up for a few extra months, hell even an extra year if it means the difference between going to a regular plastic surgeon or a plastic surgeon who really knows about gynecomastia.  You are paying for their knowledge and experience.  Do you really want to have to get a revision and go through it all over again?

Back to post-op:

My scar tissue build up continued on and remained for months and months.  I tried to massage it away which I think helped a little bit but it was still there, and my nipples still had a puffiness to them.  I remember being 5 months out and still having this problem.  In fact, it still hadn't subsided even at 7 months! It was better than it had been at 2 months, but I still had remaining scar tissue causing puffiness, and I still had a crease on my right nipple.  As for the hypo-pigmentation, the doctors were right.  It absolutely faded away.  This was a slow gradual process and I can't say for sure when it happened.  One day, somewhere around 5 months post-op, I noticed that beside from the small incision scar, the color had returned.

Fortunately at 7 months I knew what was causing my remaining puffiness, and I knew how to fix it.  I scheduled an appointment with my doctor to get kenalog injections.  Kenalog is a steroid that helps to melt away scar tissue.  There is a very good chance that you may need to get 1 or even several of these.  Many people do.  

What I want to assure you guys is that your swelling and scar tissue WILL subside.  When I think about freaking out 4 weeks post op I can't help but laugh.  Your body needs TIME to recover, so give it time and stop worrying about it!  You are not doing yourself any good by analyzing your chest every hour and working yourself up.  Relax, get off of this message board, and give it some time!

SCARRING AND CLOSING WORDS

Now, 1 month after kenalog injections, everything is looking really good.  The last bit of scar tissue seems to be going down and the crease that has been on my right nipple since literally 4 weeks post-op seems to be going away.  I am going to return for 1 or maybe even 2 more injections.  My surgeon said he would do them in small amounts until I am happy with my contour.  Honestly, I already am happy with how things have turned out, even if nothing else changes.

I wanted to speak briefly on scarring and my overall impression of this experience.  Wondering what kind of scarring I would experience was one of the scariest things for me and is for many others too.  If your surgeon does it right, he will make a small semi-circular incision following the bottom contour of your areola.  

Overall, I am very pleased with how minimal the scarring turned out.  Let me just say that is it absolutely visible, although most people would never see it unless they were close up or in weird lighting.  You have to remember that this is a surgery and there will definitely be residual scars.  Mine look like 2 very small and very thin white lines.  Some people's are more noticeable, some people's are less.  But don't for a second think that you will have no scars.  Like I said, they are barely noticeable and I have been with a few girls who haven't said anything about them.  At this point I wouldn't even be embarrassed to tell them why.  

If you are unhappy with your scars there are ways to fix it.  I may or may not get touched up by a cosmetic tattoo artist.  What they do is mix different ink to get a pigment exactly like that of your areola.  They then tattoo in the incision area and you would never even be able to tell.  If I have the time and extra money, I MIGHT get it done, but I honestly don't even feel that it is necessary.

The biggest part of this whole experience is managing your expectations.  You need to be realistic about what kind of outcome you will achieve.  If you had big puffy areolas like me, you cannot expect to come out of surgery with dime sized male-model looking areolas.  Your areolas will definitely shrink a little bit during surgery, but I have heard estimates of around 10-20%.  Depending on how big they were prior to surgery, they may still be slightly larger than "average".  Mine are slightly bigger than quarters.  

It is also unreasonable to get your surgery done in May and expect to be comfortable taking your shirt off at the beach in July.  Some people experience no swelling and minimal scar tissue and have this option, most of us don't.

I got my surgery at the end of April and was not comfortable taking my shirt off at all this summer.  Between the scar tissue causing puffiness and the hypo-pigmentation I was not about the be hanging around anywhere with my shirt off.  I thought I would be able to but that just wasn't the case.  But this next spring and summer you can be sure i'll have not even the slightest hesitation!

As people say it really might take as long as 6 months or even a year before you see your final results.  In my case at 6 months I still had some issues going on that are finally starting to resolve after kenalog injections.  Everyone is different.  Don't be discouraged or dishearted.  Your journey isn't over as soon as you step out of the operating room.  You need to possibly prepare up to a full year of time for this!

I want to wish everyone luck and I hope that no matter where you are on your journey to ridding yourself of Gynecomastia, that everything works out for you and that you may find some peace and contentment!

I will happily stick around for a few weeks to answer any questions you may have, but after that I'll be off enjoying my life!  Thanks for reading!

[Paa_Paw]

Thanks for coming back to be a source of information. As you correctly noted, we seldom hear from people once their surgery is over. People in the early post operative period often have questions that cannot be adequately answered by the rest of us here. Welcome.

[hypo123]

Exactly, I remember the first weeks and months after surgery being a time of worry, confusion, and uncertainty.  I just want people to know that if they went to a knowledgeable surgeon and had gland excised, then everything is going to be fine.  As long as you kept your expectations realistic, then you will more than likely be happy with your results.  The people who get revisions did not get their surgeries done by the gynecomastia experts.  They went to regular plastic surgeons or even general surgeons...not a good idea.

It really does take up to a full year to see your results.  I was still dealing with scar tissue and puffiness at 6 months out!  That is why the doctors have kenalog on hand.

At 8 months post-op and 1 kenalog injection down, I am still going to go back for 1 or 2 more injections.  Although at this point I am absolutely happy with my results and would have no problem taking my shirt off in front of others.  I can't wait for summer when I can wear the stylish tight t-shirts i've always wanted to and when going for a quick swim doesn't involve me awkwardly pinching my nipples and running to the cold water as fast as possible.  The difference between pre-op and post-op is incredible. 

[Jake7676]

Exactly, I remember the first weeks and months after surgery being a time of worry, confusion, and uncertainty.  I just want people to know that if they went to a knowledgeable surgeon and had gland excised, then everything is going to be fine.  As long as you kept your expectations realistic, then you will more than likely be happy with your results.  The people who get revisions did not get their surgeries done by the gynecomastia experts.  They went to regular plastic surgeons or even general surgeons...not a good idea.

It really does take up to a full year to see your results.  I was still dealing with scar tissue and puffiness at 6 months out!  That is why the doctors have kenalog on hand.

At 8 months post-op and 1 kenalog injection down, I am still going to go back for 1 or 2 more injections.  Although at this point I am absolutely happy with my results and would have no problem taking my shirt off in front of others.  I can't wait for summer when I can wear the stylish tight t-shirts i've always wanted to and when going for a quick swim doesn't involve me awkwardly pinching my nipples and running to the cold water as fast as possible.  The difference between pre-op and post-op is incredible. 

I want to have this surgery but i want to have it under local, however i may need incision and liposuction and i really dont know if that will be compatible with only local or some sedation. And if you dont mind can you tell me the name of your doctor?

[cduub]

I have the exact same questions,who's your Dr? Because I need both. Thanks for the story,it will be very helpful on this board.

[rfg6523]

Hypo,

Thank you for this great post. I am at about 5 weeks post op and going through it. When I fully recover I promise to post my story with pictures included. It is important to note that recovery is a long process and we all recover differently.

Unlike you I had to get a lot of lyposuction done, as much as 3 pounds removed from my breast area. Lyposuction isn't painful, but it will leave you bruised and create a lot of draining and swelling. Even at 5 weeks one of my breasts is still yellow and hard from healing, but things are slowly getting better. Like 2 steps forward, 1 step back, etc. At about 2 weeks post op one of my breasts got so swollen and hard that it felt like a pec of a bodybuilder. I was told to massage the area and apply heat.

I was put under with general anesthesia, and it was nothing. I see a lot of posts on here with people fretting it, and it should be the least of your concerns.

My doc did not go with semi-circular insicions, instead went with zig-zag incisions at the bottom of the areola. The lyposuction incisions are at the bottom of the breasts.

While doing consultations pre-op, be sure to ask for before/after photos of prior gynecomastia patients. My doc had a lot of before/afters that compared with mine. My doc was also referenced on here a couple of times.

I wore the nasty, suffocating compression vest for 1 week post op, then my doc let me go to a standard fitting underarmour shirt. Because I am still dealing with bruising from the lypo, my doc is advising to wear underarmour during the day for another few weeks.

I was not aware how difficult recovery is, but I am still glad I had surgery. I agree with hypo that the only post-op stuff you read on here is people freaking out during the early stages of recovery.

[jay2soul]

Hi Hypo,

Quick question:

How long after the first injections did you see a noticeable difference?

Thanks in advance!

Jay

[someone3]

Thank you!
I'm having gynecomastia surgery under local anesthesia next monday and I was just about to create a post regarding the procedure, where I was going to ask how it is done and how to handle the situation when you're in it. Since I tend to over-think situations I'm pretty scared that I'll freak out 5 minutes before surgery.

Massive credit to you for writing this post and informing us how your case went!

[jay adams]

I just wanted to bring this back for people questioning the healing process. This can calm your nerves for sure.

[lurkin505]

I am about to go under in 3 days, this coming Monday. I am a little anxious and nervous... My expectations are not to take my shirt off until the healing takes its process. I was wondering what do you think it will the results look like after a month?

[jay adams]

So many variables. The doc, how you heal, if the surgery goes smooth etc...

In four weeks you might want to be wearing your compression still but taking it off and how long is up to your doc. I was swimming in a indoor pool at three weeks (by my docs permission). You want to stay out of the sun until the bruising goes away and then use sun block. I'd take off my compression for a couple hours a day at three weeks.

I'm 9 weeks and I don't wear a shirt for nothing. If I go somewhere where I have to wear it I will. You'll experience swelling, contour changes for months but after the first month you should look pretty good if you have a good doc, wear compression and eat healthy.

[Nips]

Kudos to the guy who wrote the lengthy post. I'm two days out of surgery and pretty nervous already. I don't think the post-surgery topic got enough discussion pre-surgery. This definitely helps and I guess it's just patience and not setting your hopes too high too soon.

[jay adams]

This should be a sticky. Everything in here takes a long time to find individually.