I had surgery but I don't think it made much difference (pics included)

[derekthepirate]

Hi guys.
So I actually think I once posted here, in late 2013, before I had laser liposuction surgery, but unfortunately I can't find the post or the pics. To cut a long story short, I live in the Middle East and was diagnosed with 'pseudogynecomastia' - via email I was told 'You have abnormal fat deposition in your breast without any glandular hypertrophy (grade 1 gynaecomastia), the best treatment for it is laser liposuction'. I was told there was no gland tissue. I went for blood tests prior to the surgery and no hormonal imbalance was found.
I had the surgery and now, over 18 months later, I have continued to have a white ring around my nipples, puffy nipples, and a droopy look to my chest that I don't think corresponds with the rest of my body and fat distribution. The lipo seems to have removed below the nipples, so things don't sag like they used to (this is noticeable in IMG_1730 below, where I push my chest together), but everything above and to the side of the nipples area is quite soft. 
I have attached some images of how things are - you might be able to see the incision scars below the nipples. So was I misdiagnosed and still have gynecomastia with gland tissue or do I just have puffy nipples? I await your expertise. Thanks.

[derekthepirate]

Here are a few more images

[walt]

as you said and I don't see much difference , if you feel better thats all that matters

[derekthepirate]

as you said and I don't see much difference , if you feel better thats all that matters

Sorry if there's any confusion but these are all 'After' images - the 'Before' images were only on a post that I'm unfortunately unable to find. I don't feel great about the above results, hence I'm wondering if perhaps I need revision surgery or if there are different options available.

[Alchemist]

Hi Derekthepirate,

I worked reviewing group health plans.  I'm a software and data consultant. I make reports to managers and gather and work over data for management. Plan member satisfaction was an important thing to consider.  It was often difficult to sort it all out.

I can see the that these are all post surgical giving your nipples sort of an elongated shape with a crease down the middle and a slight change in contour underneath the nipples as you mentioned.
What did you realistically expect, not to be confused with "ideal" desires?  As soon as I looked at a bunch of before and after pictures of guys my size, I knew there was no possibility that I could be satisfied, all other considerations aside.
I am not any kind of expert, such as the doctors here, so don't take what I have said as anything other than my opinion for myself.  I just have to ask the question.  The doctors here can give their opinions which will be far more accurate about your case than I can be.

[derekthepirate]

My only real expectation was that the puffiness would go, and since that hasn't been the case I wanted to post the above pics and find out if maybe I was misdiagnosed originally.

[Dr. Elliot Jacobs]

You have residual tissue present, which is most likely due to gland tissue remaining.  Virtually all gynecomastia has some amount of breast (gland) tissue present -- and laser lipo, which has been hyped as the "latest and greatest" does not address gland tissue at all.

There are no alternative treatments except for revision surgery.  Just for the record, revision surgery is made more difficult and less predictable due to the presence of scar tissue under the skin (in all directions), which is the natural consequence of any surgery.  In my experience, the scarring from prior laser lipo is even more difficult to work through because the laser energy originally used creates localized mini burns which heals with very dense scar tissue.

Would strongly suggest that you seek the opinion of an experienced gyne surgeon.

Good luck!

Dr Jacobs 

[derekthepirate]

Thanks for that. I figured that may be the situation but good to have it in writing from an expert. Very frustrating and feels like my operation was only half-complete but I'll figure something out. Thanks again.