3 months post op ABUNDANCE OF SCAR TISSUE

[Scartissueissue]

Hi,
I could rant for pages but I'll try to keep it short.
I had a very minor case of gyno but it drove me nuts.  I did the surgery with a very reputable plastic surgeon in Toronto on Jan 9th.
For 3 to 4 weeks after my chest looked like a dream when removing the vest.  After 4 weeks scar tissue rapidly developed and it looks horrible.  It is at least 4 times worse and larger than the glandular tissue that was removed.  I am now 12 weeks and it looks worse every day.  I massage constantly.
Firstly, it is not remaining breast tissue.  I had very little to begin with and this is much worse than I ever have.  Shows up through shirts far worse...this is what I was trying to FIX!
2 weeks ago I saw my doctor.  He was visibly uncomfortable with how much scar tissue was there.  But he DOES NOT believe in kenalog injections.  This bothers me.  He says it does more harm than good but I have read nothing but great stories from Elliot Jacobs.

He would rather wait a year for a scar tissue removal surgery which I do not want.  I need fast results.  I want my life back.  Please...let me know my options.  Are there any other surgeons within Toronto/Ontario who will do kenalog injections on someone elses's patient?

[Dr. Elliot Jacobs]

At 3 months, you are right in the middle of the most intense scar tissue production.  As much as it may pain you, it might be better to wait until at least six months has passed.

In my practice, I virtually never operate for scar tissue because you will just get more scar tissue.  Rather, a series of carefully placed, strong Kenalog injections will often improve the situation dramatically.  Perhaps you should seek the opinion of another plastic surgeon in your area who might just be willing to do the Kenalog injections.

Good luck!

Dr Jacobs

[Dr. Schuster]

I find it unusual that your scar tissue has built up so that you larger than before surgery. In my experience, when scar tissue has developed it is small and simply feels like a small lump. Kenalog works great for this. Perhaps photos would help to explain a lot. Another option might be to see a physical therapist who could use ultrasound or iontophoresis to help break down the scar tissue. 

[Scartissueissue]

It's definitely much worse than before surgery, that's for sure.  But remember i had a very minor case...basically puffy nipples and maybe a little extra.  It's bad under both nipples but I would say it is at least twice as bad on the left.
Dr. Lista was my surgeon.  A very good and reputable surgeon, as I'm sure you all know.  My concern is that he doesn't believe in Kenalog injections.  He feels in his experience they cause more harm than good and that the risk is too high.  I've read many posts by Dr. Elliot Jacobs and while he agrees they can be risky in breaking down too much tissue/leaving an indent, this risk is mitigated substantially when performed by a skillful surgeon who has an abundance of experience in administering kenalog injections.
He would prefer to wait and even went as far as to suggest a procedure after a year to remove the scar tissue surgically...even though he agreed that could risk more scar tissue.

It is worse every day.  So what do I do?  I think kenalog injections are my best chance but my surgeon doesn't believe in them. 

[DrPensler]

In cases like this photos are useful. As an aside I find kenalog injections useful but there are certainly limitations.

[Scartissueissue]

Hi,
It's continued to get worse every day.  At this point I would pay money to have my gynecomastia back.  Not only are the nipples puffy again, far puffier than before the surgery... but the tissue surrounding the nipples are also puffy, full, and protruding, like little breasts.  I had before what was considered some of the most minor case of gyno...so I never experienced anything to this degree. The other thing is the actual nipples are larger.  So not just the areola but the nipples on top of the areola are wider, thicker, and much longer.  When I raise my arm the scar tissue below and above the left nipple is massive, the size of a walnut or a larger hersheys kiss chocolate.
I could take pictures but it bothers me greatly to even look at it let alone document it in actual photos. 
Should I empty my savings to fly to Dr. Jacobs to have an experienced surgeon in kenalog inject the scar tissue?  I have prior engagements in early June that I need my chest at least 50 percent better. 
I'm almost 14 weeks.  Look, I'm not looking for the final result at 4 months, though I was really hoping for it by June which is in 6 months.  Right now I'd settle just for as bad as what I had going into the surgery which I don't think is asking for much.  If it was even getting a little better I could possibly be patient, but it is getting worse and worse each day. 

[Dr. Elliot Jacobs]

So sorry to hear about your situation.  What you are describing is not the typical way in which scar tissue presents.  And if the amount of tissue is as great as you describe, then kenalog alone may not suffice to treat it.

You should speak to your surgeon and specifically ask him/her if they removed all the breast tissue under the areola.  If not, there is the possibility that this may be breast re-growth (not scar tissue) which would not respond to kenalog.  You should also check your hormones to make sure there is no hormonal stimulation going on.

Dr Jacobs

[Scartissueissue]

Thank you very much for your prompt reply, Dr. Jacobs.  From what I understand, breast regrowth is very common, is it not?  And considering what I am experiencing is much, much larger in size than the gynecomastia I experienced before, then it would have had to have grown back faster and larger than what I had experienced for 9 years prior.  Does that sometimes happen as well?
When rubbing it with my fingers, it does feel more lie what I would imagine scar tissue would be like than compared to gland.  It is tough, and thick, but when I press deep into it with my fingers, some of it can be manipulated slightly like a stick of gum or clay.  Is that what scar tissue can be like?

[Dr. Elliot Jacobs]

Yes, breast re-growth is rare but not impossible.  That is why I recommended you check your hormones -- to see if your breasts are being stimulated.

It is difficult to differentiate scar tissue from breast tissue merely by feel.

Dr Jacobs

[Scartissueissue]

This is me 4 weeks after surgery...

[Scartissueissue]

This is me today...13.5 weeks post surgery...don't know what to do...

[Scartissueissue]

Ugh...

[Scartissueissue]

Any other advice?
I had a kenalog injection by a different doctor on my left side, which is my worse side.  The right one looked enough better so he decided to not administer one there.  However, since then my right one has blown back up.  I'm not sure why
Also, do you guys have any idea what would cause the actual nipple to be thicker and longer?  I'm not talking about the areola.  Throughout my life even with gynecomastia my actual nipple was nothing more than a small raised bump, even when erect.  But since this whole healing debacle it is much thicker and elongated. \
I'm almost 18 weeks.  4 months and 2 weeks.  Is it normal to still have this much swelling?  Scar tissue aside, I definitely still have swelling tissue around the lower pec and surrounding nipple area.

[Litlriki]

Sorry to be late to the conversation, but I have a few thoughts that haven't been raised. 
First off, in patients with very mild gynecomastia of the type you've described, I warn them pre-operatively that sometimes during the post-operative period, the scar tissue can appear worse than the original gynecomastia.  Your appearance at 4 weeks is consistent with this, as at that early point, less scar tissue may be apparent PLUS in my patients, they're still wearing compression.  The compression will keep swelling in the sub-areolar remnant to a minimum. At 4 weeks, I discontinue compression, and quite commonly, patients will notice some increase in the puffiness around the nipple and some thickening of the chest overall around the areolae.  As healing progresses, this "swelling" resolves, and things even out in terms of fluid distribution in the tissue. Around the same time, if scar tissue is being laid down and swelling develops under the areola, this may be even more prominent, since fat may have been removed with the liposuction.  I will see these patients back 2 - 3 months post-operatively to consider a Kenalog injection, but only if they need it based on appearance.  This can be very effective and the result is obvious within 4 - 6 weeks.  I'll repeat as needed, using a low dose and being careful to stay in the scar tissue and deep tissue to avoid complications. 
Good luck!
Rick Silverman

[Scartissueissue]

So I'm almost 19 weeks post op.  Everything still looks awful.  Not really sure what to do.  Still way worse than before surgery.  Confidence is in the gutter.