Almost 4 months post op... Back to puffy

[Crea]

Hey all I am about 4 months post op now. Everything looked great at the beginning (like most people) and now my nips are puffing back out. I know people say to wait it out but isn't 4 months post op a lot of time?

Anyways, just looking for some answers. I'm assuming/hoping it's just scar tissue. In that case I'm really hoping cortizone shots are what could fix it. Anyone have any suggestions on that, since I am seeing my doctor on Monday. Here are a couple pics of what it looks like now. I'll post some pre op and week post op as well once I switch computers.

[ha032742]

It'd be unusual for scar tissue to suddenly appear after 3-4 months I would have thought? I was under the impression scar tissue tends to form at the 3-4 week point. I'm presuming you had gland excision with lipo (think I can see an scar around the areola)? It could be residual gland but I'd see the surgeon as planned on Monday and get his opinion.

[Crea]

Well I would say the scar tissue has been there for a while, (Probably around 2 months after surgery) but I thought it would disappear/improve over time since it was still early.

Yes it was gland and lypo.

[ha032742]

If that's the case, it may well be a combination of scar tissue and some residual gland (see Dr Jacobs' quote below). You may benefit from a Kenalog injection if there significant scar tissue but again something for your surgeon to decide after examination and he/she may want to wait for a couple more months first as it can take 6 months or more to see the final result post-surgery

There's more discussion on scar tissue and puffiness in this thread:
https://www.gynecomastia.org/smf/14/does-scar-tissue-cause-puffiness/msg125124/#msg125124

To answer the original question, I have never seen scar tissue cause a true puffy nipple.  I suspect you may have residual gland present -- but that should be checked with your original surgeon.

Dr Jacobs

[Crea]

Here are some more pics.

As you can see for the first pic. They are the pre op, a couple days right before surgery actually. The nipples really protrude here, clearly puffy nipples.

[Crea]

This pic is me about a week or so after surgery. Perfectly flat, great looking chest.

[jinr0h]

speaking of my own experience, i believe they might not have been flat right after surgery, my guess is that the compression garment put pressure on the nipples to make them sink in temporarily. Cause when i wear mine vest now my chest looks fine, but when i take it off they puff out again. Either that or its scar tissue

[Dr. Elliot Jacobs]

Only your surgeon truly know how much gland was removed -- he was there!!

In general, if you are reasonably smooth and flat after surgery, and then your nipples begin to protrude a bit, then it is probably scar tissue.  Scar tissue takes time to develop.  It usually begins a few weeks after surgery and then gradually builds over the ensuing 12 weeks or more.  Most guys won't even notice it.  In some guys, though, it can detract from the initial operative results.

It is best to return to your surgeon for an evaluation.  If it is scar tissue, then no additional surgery is needed but merely one or more injections of cortisone.

Good luck!

Dr Jacobs

[Crea]

Thanks for the info doc. So I should just ask my doctor to do the cortizone right away? I mean I went from super satisfied to boarder line depressed when I saw the puffiness returning.

[jason_w]

i still think you look good bro, i would pay anything to have a flatter chest, im waiting on surgery atm

[Crea]

Thanks bro.

Seeing my doc on Monday coming up. Going to bring up the puffiness returning (hopefully seeing my chest will be obviously enough). The last time I saw him they were still flat which was a month in a half or so ago.

I'm just praying its scar tissue and is able to be solved via kenalog. I Can't lie, I'd be very upset If he tells me a revision will be needed. It'd be very discouraging especially after all the work I've put in to get back to 100%.

[Crea]

Saw my doc. He was very confident in telling me not to worry at all and that it's very typical for scar tissue to be present at 4 months. I'm relieved because I thought it was gland..

He also gave me multiple kenalog injections in each side. Hoping it works!

One last question for any doctors or anyone who's had kenalog done. How long does it take to see results?

[Dr. Elliot Jacobs]

Kenalog usually takes about 6 weeks or so to exert its full effect.  I would therefore allow yourself 6-8 weeks to assess the treatment.  Sometimes additional injections are needed.

Every doctor has his own regimen for injecting, choice of medication dosage, technique for injection, etc.

Be patient.

Dr Jacobs

[Crea]

Your comments are much appreciated Dr Jacobs. My next appointment is March 2nd so I'll be playing the waiting game until then.

[Crea]

One week after the kenalog. No improvement so far. Still pointy nips and I can feel hardness under the scars still. That being said, as you've said drJacobs, this is a 6 week process.