Need advice 6 months after surgery

[silentsam]

Previous thread: https://www.gynecomastia.org/smf/index.php?topic=27607.msg180800#msg180800

I had surgery 6 months ago in California
My doctor was extremely nice and the surgery and recovery were fine.. However, my results have not been as great,

I just had my six month check up and told him of my big concerns regarding my chest.

If you read my previous thread, or just check out the pictures, you can see the problem was that my right side had a weird contour and line/dent going around it. As well as a bit of a crater.

the left side, which was the side I was told was barely level 1 gynecomastia - just a tiny marble that he would be very cautious with, had some scar tissue and swelling that made it puffy. But it wasn't the side that concerned me.

And my chest also looked very different left to right in terms of size and symmetry.

On my 4 month check up my doctor said that the dent/crease and weird shape on the right side pec would continue to get better.

For the left side, I was given a steroid injection to bring down scar tissue. Though he did not tell me he there could be side effects. Just injected it when I told him it was puffy.


After I had this injection I noticed a crater forming on that side and it has gotten worse since. Basically, unless I am 100% still with arms down, there is a deep crater. Even just moving my arm slightly so chest has to flex a tiny bit.


At this six month check up I was told by the nurse that these shots can cause tissue to flatten…. Did not know that!

Dr told me nicely that he would definitely not touch me for a revision right now. He said he was happy with how I looked. Said people would barely notice……

He again said time could change how the results look and to come back in 6 months.

I asked about the left side and he said that it was 'nature of the beast' that you can't have a chest that is flat when you have your hands up and down.

He said he would not look at fat flaps or anything for the cratering of the left side.


I don't know what to do from here. I don't expect perfect results but I barely had more than a minor case of tiny puffy nipple on the left side and a bigger level 2 gland on the right side.

I went with the more expensive surgeon and the patient co-ordinator told me that I could go with another doctor in California but a lot of patients come to them for revisions.

In the end I am thinking I live with it or do need a revision. Sigh.


Pictures:


This picture is me totally relaxed with arms to my sides. See the crease and weirdness of my right side.



This is my chest 'slightly' flexed, hardly no flex at all.


Big flex looking straight on.



right side (my right) relaxed - you can see the line and crease. Left side is lightly flexed, showing crater.


lying down or sitting up, moving arms or even just lightly flexing, the top of my nipple caves in and slopes down. Here you can see from a laying position that it slopes and comes back up. sunken in even when relaxed and lying down. S

[Litlriki]

Sorry to read about your issues with your surgery.  I looked back at your previous posting as well, and it does seem that your situation on the left is worse than it was prior to the steroid injection, which is unfortunate.  The steroid injection can cause dermal or fat atrophy, and I tend to be conservative with this in terms of using a low dosage, which can be repeated if needed.  Your surgeon may have followed a similar course, but you've had the bad luck of developing some tissue atrophy nonetheless.  At this point, you may want to leave the left side alone for a while longer to be sure that the deformity is stable.  The right side seems better than in your previous posts, and it may continue to improve.  I would be hesitant to jump into any revision still, though you may require something down the road--a little liposuction with some fat redistribution/grafting.  I'm not sure that fat flaps would be effective for the appearance.  Also, it's common to have some irregularities with flexion that will continue to improve over the first post-op year.  My preference is to hold off on revisions for a minimum of 9 months to a year, since improvement may occur without intervention, and as you've learned, each intervention brings new risks.

Rick Silverman

[DrPensler]

Do you have a photo without any muscle contraction? A photo in the absence of active muscular contraction would help in the assessment.

[silentsam]

Sorry to read about your issues with your surgery.  I looked back at your previous posting as well, and it does seem that your situation on the left is worse than it was prior to the steroid injection, which is unfortunate.  The steroid injection can cause dermal or fat atrophy, and I tend to be conservative with this in terms of using a low dosage, which can be repeated if needed.  Your surgeon may have followed a similar course, but you've had the bad luck of developing some tissue atrophy nonetheless.  At this point, you may want to leave the left side alone for a while longer to be sure that the deformity is stable.  The right side seems better than in your previous posts, and it may continue to improve.  I would be hesitant to jump into any revision still, though you may require something down the road--a little liposuction with some fat redistribution/grafting.  I'm not sure that fat flaps would be effective for the appearance.  Also, it's common to have some irregularities with flexion that will continue to improve over the first post-op year.  My preference is to hold off on revisions for a minimum of 9 months to a year, since improvement may occur without intervention, and as you've learned, each intervention brings new risks.

Rick Silverman

Wow, what an amazing post! You really took the time out to address everything for me.. Including going back to my old post - Thank you doctor Silverman! I guess my plastic surgeon is right to hold off for another few months.

The right side tissue seems to be tougher around where the crease/line is. Not sure if it's scar tissue or gland that's causing that appearance.

I just had one shot of steroid injection in the left side. It showed up after 2-3 weeks from that injection day. Do you know if this ever fills back in or is the tissue done for good? It was something I was not aware of - that it could flatten tissue.

Thanks in advance.

[Litlriki]

The atrophy that occurs from the corticosteroid injection doesn't resolve on its own, to the best of my knowledge.  We occasionally see patients in whom such an injection was used in a tendon or joint, and they develop dermal or fat atrophy in the overlying tissue. It's generally a fairly stable change when it happens.

RS