Exactly 1 Year Post Op

[teatake2011]

Hi docs, I had my surgery August 2013 and I just had a few questions. First I want to tell you what happened during the last 11 months. So right after I got my surgery, my chest was perfect. It was very flat. But this only lasted until my drains were pulled out. About 2-3 weeks after the surgery, I went to my surgeons office to get my drains taken out. She patched me up after taking them out and sent me home. When I got home and took off my shirt I noticed there was a lot of blood leaking through my compression vest from where the right drain was taken out. I guess I started bleeding after. So a week later I noticed my right side was a little swollen (where the drains were taken out and bled a lot). And my left side was different. The left side was red like as if there was bleeding on the inside. Since the right side had leaked out all of the blood it wasn't that bad. But I went back to my surgeons office and she said it looks like there was internal bleeding from taking out the drain and blood was piling up inside. She didn't do anything about it and said it would go away on its own. Went back 2 weeks later and it did look a little better. But One month after this, I noticed hard lumps forming where the drains were taken out on both sides. The lumps seem like they are shaped just like a drain (tube shaped). They go from my arm pit to under my nipple. The left side is alot worse because I guess the blood that was left in there turned into hard tissue. And it is making my chest protrude. My right side isn't bad but it is a little puffy. My surgeon then decided to give me steroid injections. She gave me probably 4 on the left side (1 month at a time) and one on the right. The tissue has softened but it still protrudes. I have been working out and it seems like it is improving the contour but I'm not completely sure. This has been driving me crazy. I also think she has not been using enough cortisone or not injecting it in the right spots. My question is what should I do about this. Should I keep working out? it is only noticeable through tight shirts and when I sit down. When i Stand up it looks a lot better. When I push down on them you can't feel the lumps. You can only feel the lumps if I pinch them. I have been massaging them but I guess I haven't been doing it enough. Please give me any suggestions, I am really not looking forward to going in for a revision after spending over $4K. I like the results but am hoping to improve the contour. I will continue working out and losing some weight, even though I am not overweight. I am also going to see my surgeon again in October. (By the way when I am cold my chest looks perfectly flat)

Heres some extra info about myself:
148 lbs
5 ft 7in
20 years old

[teatake2011]

Pre op and 9 days post op picture

[teatake2011]

First 2 pics (relaxed), third one I'm flexing lol (took these pictures yesterday)

[teatake2011]

When i'm cold

[teatake2011]

Anyone?

[Dr. Elliot Jacobs]

You probably have some buildup of scar tissue secondary to the bleeding episodes that you described.

Best to return to your surgeon for evaluation and possible treatment with cortisone injections.

Dr Jacobs

[teatake2011]

Thank you for the reply doc! Do you think it is a good idea to go in for a revision and get the scar tissue removed? I know there is a chance that it might come back but it was most likely caused by the drains. This has been driving me crazy for the past couple of weeks. I don't know what to do. And would the injections help tighten my skin? I am working out my chest alot more and it seems to be helping.

Thank you.

[Dr. Elliot Jacobs]

Cortisone (usually Kenalog) injections can help to diminish a limited amount of scar tissue.  If is not useful (the doses would be too high) for large areas of scar tissue.  Surgery to remove scar tissue simply doesn't exist.  And if it did, you would simply make more scar tissue in those areas.

Sometimes there is residual fat/breast/scar tissue that can indeed be treated -- best to seek a surgeon who is experienced in revision operations.

Also, cortisone injections do not tighten skin -- sorry.

Hope this has helped.

Dr Jacobs

[teatake2011]

Thanks that did help. I guess i'm better off massaging, working out and getting more injections. Not going to risk the results with a revision. They are not too bad, just noticeable through a t-shirt. I don't think my surgeon has a lot of experience with cortisone injections. She does a great job of listening to me. Even offered more liposuction which I don't think will help. She also offered to do a revision but I denied it. She will keep giving them to me until i'm satisfied. The area has softened but there are still hard spots.

[teatake2011]

I have one last questions Dr. Jacobs. Its been 5 weeks since my last cortisone injection. I am now able to pinch the big scar tissue lumps and break parts of it off. Now I have smaller parts of the original golf ball sized lumps floating around in my chest. I can move them around (pea sized). Will these eventually go away? And If I continued to work out. Would my chest muscle push out the scar and make it more noticeable? Breaking away these small lumps have not changed the contour of my chest.

Thanks again.

[Dr. Elliot Jacobs]

These are questions you should direct to the doctor who has performed the injections.

Just some general thoughts:  the production of scar tissue is the normal way in which the body heals.  Sometimes the body is over-zealous in making scar tissue -- and then we use cortisone to soften and minimize it.  But scar tissue itself is not the "big evil."  The main purpose to use cortisone is to reduce the volume of scar tissue so that the contours are acceptable to the patient.  There is no guarantee (or need) for you to be constantly feeling your chest for the presence of scar tissue -- it will always be there to some extent.  And there is no need to press and mash on your chest to further break up any pea-sized bits of scar tissue.

Remember -- you have the surgery and any post op cortisone treatments so that your chest appears normal to others.  You need not have others pass the "feel my nipples and see if you feel anything hard" test.  I can assure you -- most other people are not interested in feeling your nipples for some perceived scar tissue.

Dr Jacobs

[teatake2011]

Makes sense. Thanks a lot!