What is causing the area behind the nipple to be rock hard 4 mos.after surgery?

[ozark1]

Although I am meeting with a second plastic surgeon in a few weeks, what is your opinion at what is causing the area directly behind each nipple to be rock hard? The nipples are also darker in color than pre surgery. This is 5 months post surgery. The hard area is a larger in one breast than the other. To your knowledge is there a procedure that could soften this firmness and relieve the pain? FYI, my original surgeon put a needle in the breast area to see if he could extract anything but he could not. I understand this is rare and the other surgeon will give me his opinion, but I was just curious if, from anyones experience, you know of any procedures that could help my problem. I am 60 years old and will accept it if I am just going to have this discomfort for the rest of my life. But I remain hopeful. Thanks so much for your time.

[Dr. Elliot Jacobs]

More than likely you have developed scar tissue, which can be different on each side.  Since we don't know which patients will develop scar tissue, there is no way to prevent it from forming until after it does form.  It can be tender or even painful.  And certainly, it is disconcerting since (I presume) you were initially flat after surgery.

Treatment is often done with a series of  cortisone injections.

As for the nipple color -- this is to be anticipated after gyne surgery -- it happens to all men.  Basically the areola shrinks and the normal pigmentation is now concentrated into a smaller areaola.  There is nothing that can or should be done about this.

Dr Jacobs

[wrh90]

Hi Doc,
Quick question, how can you differentiate between what is scar tissue and what might be gland?

I ask because I underwent revision surgery 3 months ago after some regrowth and developed scar tissue shortly afterwards (as confirmed by my surgeon). This is in the area under the nipple and is slowly starting to disappear after massaging it.

However, even after three months, my gyno looks if not the same as prior to the revision, maybe worst. I started to examine it further and have noticed another bump to the left of my nipple. At this point I hope it is scar tissue but I am scared that it may be gland regrowth. Is there anyway I can make a determination?

Thanks for your help.

[Dr. Elliot Jacobs]

Your question is complicated and there is no good answer.  Part of the answer depends upon what the surgeon did at the time of your surgery.  That is, did he remove as much gland as possible?  Bear in mind, it is absolutely impossible to remove all gland -- it is distributed across the chest and any attempt to remove "everything" would leave you mutilated.  Then, one must consider the time frame in which re-growth occurred.  Scar tissue usually grows, if at all, between 4-12 weeks -- with lots of variation.

Breast re-growth very rarely occurs and never quickly.  The only exception would be if the patient went back on steroids or other meds which can stimulate breast growth.

One cannot tell the difference between scar tissue and breast tissue by feel.  And both tissues look the same in a mammogram or sonogram.  Hence the diagnosis is usually made by history taken from the patient.

My best advice is to sit down with your surgeon, review what was done during surgery, review your condition a few weeks after surgery (when scar tissue hasn't yet formed) review what has happened to you in the ensuring months, and discuss where you are now.  Remember, oftentimes the best treatment is watchful waiting -- scar tissue does tend to subside over time.  Rushing in to remove scar tissue will just result in more scar tissue later on.

Good luck!

Dr Jacobs