Doctor thoughts on this?

[David1991]

I had surgery back in early January. Got a glimpse of it right afterwards and the right side looked great. Left side looked better but still a bit puffy. As many say the end result will look similar to how it looks right after surgery and that has been the case with me.

When contracted that both look great. But when completely relaxed it still bothers me. My doctor thinks there is almost no gland left but I know there is and regardless of what is there I'm more about the look than the actual tissue, so I will just say the right side when relaxed has about 10-20% of the original gyno look to it, which is acceptable, but the left side when at its worst still has 50% of the gyno look it once had.

The problem is when I go to the doctor it's cold and the nipples are contracted. I tell him how it is when relaxed but he still is adamant about recommending against revision surgery. So finally I took a video that decided I would show him at the next appointment.


Well, just had my appointment. He said he can't treat a video and has to go by what he is seeing and feeling, and that even if it is like it is in the video 1/3 of the time I really shouldn't be worried about it because it looks great most of the time. I partially agree with him but I'm reluctant to just let it go. He said he absolutely doesn't want to do revision surgery, that he doesn't think there is anything he could really improve at this point, and that he didn't even want to do kenalog injections today because eventually the risk for indentation and discoloration is just going to be too high :\


I guess it's his choice if he wants to refuse to do revision surgery. One 'hope' I kind of have is that maybe my dissatisfaction was partly due to thinking there would be a change, and now if I "know" this is it maybe I will be able to accept it at this point. In theory. I mean I know no one else notices it at all at this point but you know how it is....I am finding this very hard to just accept, even though I know no one else would notice it and even though I would not get surgery if this is how it was INITIALLY. But because I've already had the surgery I don't want to accept anything that's at all unsatisfying

[David1991]

Here is a video showing it at it's worst. I couldn't post this video in the 1st post but if you take away the space between "https" and the colon ":" in the web link below you will be able to watch it.

https ://www.youtube.com/watch?v=pynF4wZCF0Y&feature=youtu.be

[David1991]

On the other hand here are 2 pictures I took being a complete tool lol but go to show how good it looks and with a great contour. This is how it is maybe half the time. So I'm torn because if it was always like these it would be amazing, but as you can tell from the other pics sometimes it is incredibly annoying.

[George Pope, M.D.]

You look really great. I was unable to pull up that youtube video with that link, but in your still photos you look flat on both sides.  You obviously work hard in the gym, and I understand your wanting to look perfect after having had surgery, but none of us plastic surgeons can guarantee perfect.  I think your surgeon is right - there's def. a risk of "melting" away too much tissue with a steroid injection, especially in someone like you with very little chest wall fat.
You mentioned more than once in your post that it's something no one else can see.  That should tell you right there that it's nothing to be concerned about.
Enjoy your great result!

Dr. Pope, MD

[David1991]

hey Dr. Pope, thanks for replying.

You can see the video if you get rid of the space between "Https" and the colon. It does show how it can stick out a lot and I think the pictures I posted in the original picture show that it sticks out fairly noticeably to me as well. I know most of the time it looks good but that 1/3 of the time that it pokes out really bugs me.

Having said that, your response does help. I think the two biggest issues for me at this point are that
1. I already invested the $5400 going into it looking for an ideal finished product and also, importantly,
2. Part of me feels like I could have pushed the issue more and/or still can. If I were somehow just 100% unable to do anything further about it I think it would be easier for me to move to acceptance but part of me just doesn't quite want to give up yet if I feel like there is something else that can be done (in my life in general I am often for delayed gratification so if it takes more work now for a better end result later that is generally the option I choose).

So I guess if I make the decision that "this is it, I have to accept it" then it would be mostly OK. I mean like I said if this is how it was naturally I sure wouldn't be looking into surgery, and mine is now better than my brother's who I also would not recommend surgery for, so that's something for me to consider too.

My surgeon did say he didn't think there was any more he could do surgically at this point and if he did it would come with high risk, to the point that he didn't even want to do those kenalog injections (which I don't really agree with actually) so in that sense maybe the reality is I really can't do anything else about it at this point (unless I went to an entirely new surgeon and paid for it all over again which I wouldn't do). I just hate looking down and seeing this conical shape instead of the flat well contoured shape I know it has the potential to have (since that's how it is the rest of the time).

[Litlriki]

I have had similar situations in my practice, with slight nipple puffiness post-op on one side as compared to the other.  I'm pretty meticulous in trying to be sure that the sub-areaolar remnant of gland that I leave behind is very similar from side to side, so if one side seems to be a problem, I am very willing to do a Kenalog injection using a low concentration and a small amount.  I've not run into any problems with this approach, and most of the time, it seems to resolve the issue.  It's low-risk, but there is risk, which I discuss with my patients.  Better to under treat than to over treat and end up with a depression. 

That said, you can't get your surgeon to do something he's unwilling to do, but if you are still bothered by the problem six months or a year from now, it may be worth revisiting.  I've even had a patient or two for whom I've done a minor revision in the office, surgical removing a little bit of the sub-areolar remnant, and while I've been anxious about potential contour issues afterwards, I've been pleased with the outcome.

Give it some time and see if it gets better, and if not, look into your options again.

Rick Silverman

[David1991]

I have had similar situations in my practice, with slight nipple puffiness post-op on one side as compared to the other.  I'm pretty meticulous in trying to be sure that the sub-areaolar remnant of gland that I leave behind is very similar from side to side, so if one side seems to be a problem, I am very willing to do a Kenalog injection using a low concentration and a small amount.  I've not run into any problems with this approach, and most of the time, it seems to resolve the issue.  It's low-risk, but there is risk, which I discuss with my patients.  Better to under treat than to over treat and end up with a depression. 

That said, you can't get your surgeon to do something he's unwilling to do, but if you are still bothered by the problem six months or a year from now, it may be worth revisiting.  I've even had a patient or two for whom I've done a minor revision in the office, surgical removing a little bit of the sub-areolar remnant, and while I've been anxious about potential contour issues afterwards, I've been pleased with the outcome.

Give it some time and see if it gets better, and if not, look into your options again.

Rick Silverman

You mentioned "sub-areaolar remnant of gland"....you find this to be resolved by kenalog injections? I thought the kenalog wouldn't be effective for any gland remnant and only for remaining scar tissue?

Sounds like in your minor in-office revision you were doing the surgery through the areolar area? I was trying to avoid any scarring there, my surgery was done through the armpit area as to completely avoid that and I believe if revision was done it was going to be done through the same area but that was in a hospital with all of those extra fees   

Thanks for the input. Only downside is this definitely does make me less able to relax because with this option I will probably always be fighting acceptance if I think more can be done (i.e. if I no longer had the option to make any changes I would just have to accept it and move on but knowing I could still potentially do more makes me much less likely to be willing to move on). Going by your profile picture it seems like you're really into working out so you can probably relate to the obsession for always wanting improvement in the body.

[David1991]

The pic I'm attaching is from yesterday and shows what I'm talking about. It's absolutely ridiculous. Now is it always like that? No. But it's still like that enough and I don't think a plastic surgeon on this planet would say that looks correct. What I really am most annoyed about is that every time I showed a picture or video to the doctor he said he has to go by what he sees in person and not the video/picture which CLEARLY shows the issue. We have no disagreement about what he sees in person because it's always contracted then. The issue, which he kept ignoring, is how it is when it's like this. That's the most frustrating thing because as far as I know (someone correct me if I'm wrong) the only way this could appear as it does in the picture is due to remaining breast tissue.

Tempted to call him up and ask if he is specifically refusing to do revision. Not that I want a hesitant surgeon to do a surgery begrudgingly though...