12 weeks post op - still looks a bit puffy

[HellCat]

Hi.
I had my surgery 12 weeks ago - gland excision and liposuction. Everything looked kinda flat for the first 10 days but after that it started to look somewhat same as before surgery. Is this scar tissue or not gland removed enough? Or possible swelling even though all the swelling seemed to be gone already few days post op. I know my case is very minor, but my nipples still protrude in t-shirts which bothers me..

[Dr. Schuster]

It's still a bit early o tell the final result. It is also sometimes difficult to tell if this kind of swelling is the result of scar tissue or under correction. Steroid injections can help with scar tissue so it might be worth trying if your surgeon thinks so too.

[HellCat]

It's still a bit early o tell the final result. It is also sometimes difficult to tell if this kind of swelling is the result of scar tissue or under correction. Steroid injections can help with scar tissue so it might be worth trying if your surgeon thinks so too.

Thank you for your reply Dr. Schuster!

I visited my surgeon and he said that he didn't leave almost any gland in there and if he would take more out it would cause a crater. He also showed me photos of me, which were took 4 weeks post op and I think I looked flatter than what I look currently, so it could be scar tissue, right? He said that I should wait for few more months and if the scar tissue doesn't seem to soften and flatten, he can carefully inject some cortisone. Does this sound like a good plan? Is is more effective to have cortisone injection now 3 months post op or is it still effective 6-7 months post op?

He also explained that my nipples may stick out a little just because my nipples are placed right on the ridge of my pectoral muscle and my chest structure is very bony and protruding. I've actually heard this from few other doctors in the past. Does this make any sense to you?

[Dr. Schuster]

Chest wall / rib irregularities can definitely cause nipple / breast protrusion if directly beneath the area that is protruding. I generally wait until 3 months to inject Kenalog unless there is something very obvious. it can be repeated every 6-8 weeks. It rarely requires more than 2-3 injections.

[Litlriki]

I agree with Dr. Schuster's approach to use of Kenalog--I try to hold off for a few months to allow normal healing to progress, but if there's prominence beyond what would be expected and could be due to scar tissue, the injection can be effective to settle this down.  I also caution my patients who have just puffy nipples, since if they're lean, they often experience what you're experiencing now during the early post-op period, when swelling may seem worse than what was present before surgery.  This resolves over time if the procedure was done properly, but many patients get nervous in the meantime.  When the condition is related to steroids, patients who resume steroid use (not referring to "hormone replacement"--only to "performance enhancement") are often concerned that they're getting a recurrence. It's really just a cloudy picture due to normal swelling.  
Good luck. 

[HellCat]

Thank you for your reply, Dr. Silverman.
 
However, I have started to believe that my case is because of under correction. Everything has looked the same since 1 month post op (now over 4 months post). Nipples shrunk looking good when touching them/getting cold etc, just like before my surgery. When relaxed, they only look a little bit better than before the surgery. Also when I lift my hands up behind my head, my right side goes a bit inwards. Not that much that it really bothers me, but I find it weird that it is still puffy when my arms are at rest on my sides but when lifting arms, right nipple sunks in a little bit. Is this because perhaps there was not enough tissue/fat removed from surrounding area or what can cause having both - small crater and puffiness?
I suppose I have to wait few more months before thinking about second procedure. But at the moment I'm pretty sure 2nd surgery is needed.