2,5 post op: Scar tissue / swelling / residual gland

[franco05]

Hi, my name is Franco, im from Santiago de Chile, in south America. I used to have gynecomastia since i can remember so i got tested to confirm if there was gland tissue under my chest. They run a echotomography in order to diagnose it. The results were both fat and gland tissue on my chest, so it was definitely gyne. I needed gland excision and liposuction.


I went to surgery on August 4th. The surgeon did both procedures, but decided it was better to excise gland tissue and fat from an incision below the armpit to avoid some scar deformity in the areola.


Nowadays i'm on my second month of post op. The surgery was 10 weeks ago and i'm pretty happy with results, but i have some concerns about it. Both of my nipples/areolas tend to get really puffy, you can even see both of them through the shirt. My left nipple/areola is actually more puffy than my right one, but i used to have more gland on my left side so i guess it more swollen because of that.
Is this puffiness going to fade is some time, i mean, is this puffiness cause by some swelling or scar tissue under the areola or is some residual gland tissue?


First I attached some post surgery pics, about 5 days after the surgery, when they took  off the bandages and i was left only with my compression shirt. I wore it for 1 month. I felt awesome those days, my chest was completely flat because of it. The nipple/areola look flat right after the surgery, as in the pics.


Also i attached som 10 weeks post op pics. My chest look great to me, except the areola/nipple. Both tend to get puffy. I'm hoping it's scar tissue or swelling because i really don't want to go under surgery again. I've been massaging the area for the last week, and i've found some hard lumps which i asume are scar tissue. I hope you can guide me on what to expect or do. If i rise my arms my chest look totally flat, the same happens if i lay down, or if my nipples get hard. 


I went to check with my physician last month. He said it was going to fade away so im giving it time to heal, but there is no wrong in asking for some second opinions since it's been a month from last consultation.


PD: sorry for my english, i've been reading lots of topic before asking but it was time to find more specific answers.

[franco05]

here are some 10 weeks pos op pics

[franco05]

and some more

[Dr. Elliot Jacobs]

It is difficult to determine whether you have residual gland under the nipples (which may not have been totally removed at the time of surgery) or have developed scar tissue under the areolas.  The best person to answer your question is your surgeon, who knows exactly what was done and what it looked like at the end of surgery on the operating table.

Be patient and return to your surgeon with this question.

Dr Jacobs

[franco05]

Dr. Jacobs, thanks you so much for your answer. I've been reading a lot about scar tissue developing under areola. Most of the cases i've read choose to go after kenalog injection to dissolve it or make it smaller. I would like to know if its really necessary to use kenalog injections to get great result if you have developed scar tissue under your areolas. Can time and massage fix it? I'm not really interested into kenalog injection and i have no real problem in waiting some more time to get great results.
I'm trying to get a new consult with my physician but with halloweens and my studies im really busy.

[Dr. Elliot Jacobs]

There is certainly no harm in waiting and trying massage -- time will tell.

Dr Jacobs

[Dr. Schuster]

I think you've come a long way and have a very nice result so far. I'm not sure if you are describing some scar tissue beneath the nipple or if it is actually the areola that you are having an issue with. One thing that I see is that before surgery your areola was very stretched out. As your entire breast skin is now shrinking there is contraction of the areola. This is causing some "thickening" of the areola which is adding some "puffiness". It is still too early to do anything but if tis is the ase, and should it continue to bother you, it would need some removal of the areola. Hopefully you'll be happy when your healing is complete. Give it another few months.

[franco05]

Thank you Dr. Schuster and Dr. Jacobs for your answers. I'm anxious to see finale results but im aware i'm going to have to wait some more time. Since my first post, my right nipple/areola has been suffering some changes so i'm waiting for them to keep changing until im fully heal.
Her are two new pictures. The first one shows some new changes on my right areola. When the areola is "soft", you can sea a little crease above the nipple.
The second picture is from my chest when im laying down on my side. My areola and the skin around it are pretty loose.

[Dr. Schuster]

Thanks for the follow up. I can't recall how long it has been since your surgery. In general I think that most of the healing should be done by 3 months after surgery, though the return of full feeling can certainly take longer. I understand what you are concerned about. Without an exam it is difficult to tell if there is residual tissue beneath the nipple or if the problem is due to having a very "soft" areola. It also looks like you may have some general skin laxity that would prevent your skin from shrinking optimally. hang in there an follow your surgeon's instructions and keep the lines of communication open. Good luck.

[Litlriki]

I would echo Drs. Jacobs and Schuster with regard to your  results. You are well on your way to a good final outcome.  The "soft" areolae are common in patients who have a large distended areola pre-operatively, and I sometimes caution patients with regard to how this may look post-operatively, since these areolae tend to be wrinkled or creased looking on occasion, and in a few cases, I've performed areola reduction secondarily under local anesthesia after six months to a year, if the areola is still puffy or big looking.  In some cases, the persistent puffiness is related to swelling and scarring, and in those cases, Kenalog leads to rapid improvement most of the time.  If it's the skin of the areola, less improvement will be gained by the injection.
Rick Silverman

[franco05]

Again, thank you Dr. Schuster and dr. Dr. Silverman for your answers. I have already reached 3 months of healing last week. If i squeeze my areolas i can definitely feel a hard and large mass right under both of my areolas. I'm trying to keep confidence it is scar tissue, since after surgery, and for a couple of week, my chest was completely flat when i took off my compression vest to take showers. I'm gonna keep waiting for some more time meanwhile i try to get an appointment with my physician.
I'll keep posting any improvement.

[franco05]

I've been trying to be as patience as i can. So far it's been 4 month and 1 week since surgery. Since my last post op pictures there has been no mayor change. Both nipple are still puffing out even when i lay down, and you can see both of them through t-shirts. Also I can still feel a pretty hard mass under both areolas. Both nipple still hurt a bit when i apply pressure to them.

I finally got an appointment to check my situation with my physician this friday to ask him what he thinks about this situation and what we should do next. I'll be posting here what he says to me in order to get some others opinions.

Thanks!

[franco05]

I had my appointment with my physician yesterday. I asked him about my situation and he suggested to wait a little more. Its been 4 moths and 10 days since surgery, so we decided to meet again in 2 or 3 months more, when i have reached 6 month post op. Then, we will evaluate the results in order to decide whether we use some kenalog injections or not.
I'm really curious about what could happen if you get kenalog injection and there is no scar tissue under your nipples but if gland. 
So i'll be posting some new information and pictures soon.

[Dr. Schuster]

Sounds like a good reasonable approach. Good luck.

[Litlriki]

Without knowing the actual dimensions of the small remnant that was left behind under the nipple areolar complex, it's impossible to know if the persistent lumps are related to scar tissue or persistent gynecagmstai.  If it's scar tissue, the kenalog may help with regression of the scar tissue and flattening of the lumps.  If it's gynecomastia tissue, it's likely that only additional resection will help.