Scar placed 1" below nipple - getting larger with time

[orion]

For some reason, my surgeon placed 1 scar under each nipple, and 1 in the peri-areolar area.  He said, pre-op, that he'd do it through the armpit (and later denied sayign that & said he "always" does it through the chest).  Not a single one of his before and after photos have pics of men with scars on the front of their chest, however.  He was able to get all the fat out of the lateral chest, which is great - but I thought this could have been done through the arm pit...not the middle of my chest where it's so obvious and lined up (and I am not always this hairy).

1. Is it even standard practice to do lipo through an incision directly on the front of the chest like this?  Why do you think this happened?   (I had a lot of lipo and fat transfer, which hit the max at 5 hours - so maybe it was a shortcut?)

2.  Is there any chance this is going to improve?  Or, will it keep spreading like the scar on my back (pic)?  Can it become hypertrophic?

I healed poorly from a lipoma excision on my back (that scar is 10 years old) and my brother actually got a hypertrophic scar on his chest and had to go through kenalog and 5-fu for years since it kept coming back.  I am not at the hypertrophic stage (yet) since it is only 3 months, but I am concerned it may happen.  So, just wanted to know if there's anything I can do (or not do) to stop this from getting worse.  My dermatologist prescribed me celacyn and I already used the whole bottle. I don't think it does anything. Silicone scar sheets don't stick to hairy areas very well, but I used them a little bit.

I know the contour is a lot better, and I am happy about that - but having these 2 scars was not what I was anticipating.


Before and 2 Weeks After:


Scar after 3 months (darker and wider)




Scar on my back (10 years old):  http://imgur.com/Yfpu0qz

[Litlriki]

There are many options for placement of incisions for gynecomastia surgery, and while I use the fold near the armpit to hide one of my incisions, I have used incisions in random spots on the chest to do "touch-up" procedures under local.  By using incisions that are closer to the spot being worked on, these more minor procedures can be done with straight local anesthesia, and they're well tolerated. The scars typically fade without a problem, and they're usually about 1/4 inch long. In your case, that scar should fade, though I'm not sure why he would tell you one plan and then carry out the procedure using a different option. Knowing that you had fat grafting and so on, there may have been some rationale for moving the incision, and your surgeon might be able to tell you why.  
As for scar management now that the scars are there, the silicone gel products for scar treatment are effective, and the ointment-style products or the type that are applied with a lacquer may work better than the sheets due to the hair. Gentle massage and time will likely fade those scar to be barely perceptible.  Scars of the mid-sternal region are more likely to develop into hypertrophic scars, so the position of your sibling's scar may explain the problem better, depending on if it were more in the mid-line.

[orion]

Thanks Dr. Silverman. 

[DrPensler]

I do not know why someone would make an incision there. Also 5 hours for the surgery is also not normal.

[Dr. Schuster]

I ca understand that you are concerned about how the surgery was performed and can certainly pursue discussing this wit your surgeon. 5 hours is a bit long for an experienced gynecomastia surgeon nd perhaps he made an additional incision to perform the surgery. It looks like you have gotten very good results. The scar is short and in the correct orientation. Chances are that it will not spread like the one on your back. And, unless you are planning on shaving your chest, no one will see the scar.

[orion]

Thanks for reading my post & your comments.  The surgery length was due to more than just gyno.  In total,  I had 6 areas of lipo done with some fat transfer to the butt, so the estimate was around 3-4.  The other issue was that he said I had fat that was so dense it was like doing a revision surgery.  His assistant also said he rarely had to work so hard in 17 years on a regular lipo case. (This was regular tumescent lipo.)  

I think my result is good overall except for the scars not being discussed and the upper abs being left out - which is a different issue & not really for this site. But, for some reason, he drew a line above my belly button, and I was too nervous pre-op to really understand what it meant (that's where he stopped the abdominal lipo).  Now that a lot of swelling is gone at 3 months post, it looks a bit weird to have fat on the upper abs but not the bottom.  It feels strange too - like I have this firm fat pad in my upper abs, and then sort of no fat below it.  It's hard to reach some doctors to talk about issues, and when I did bring up the chest scar he was a little defensive about it being his standard procedure & it was too early to worry about it.  I never mentioned the upper abs.  I am not even sure if it is worth it.  I am a little early to judge it, I think (still numb a little in the flanks).  

Anyway, I guess I will just wait and see what happens with this scar. The good news from your posts is it is less likely to spread than my back scar and also less likely to turn into a hypertrophic scar, which were my two main concerns.  I will sometimes clip the hair in the summer a little more - and the 2 scars are parallel, under each nipple, so it would just look odd on the beach or by a pool especially if it got darker or thicker.  But if it'll shrink and lighten, then that's fine.  I just wish they weren't right there.  Thanks again.