3.5 month scar tissue question

[Fisher]

I am 41 and had excision only 3.5 months ago for very mild gyno that has bothered me since my teens (puffy areola). I was awake during the surgery and even saw what was removed on both sides. Both sides were flat immediately after the surgery, but at 2 weeks the right side was very swollen. My doctor said it wasn't fluid and wanted to wait. It eventually went down, but by  3 months, a quarter shaped lump is now under the right side. The bottom half is consistent with the incision site and very hard. The top half of the full circle lump is raised a bit more, softer and seems to swell just a bit. When I massage it's almost like it drains (swelling and soft part), and then I can feel the hard irregular (scar tissue below).  My Dr said 2 weeks ago it is scar tissue, and wants to wait 2 more months to consider a kenalog injection which I am good with.

My question is  it normal for scar tissue to show up as late as 3 months, peak, and not change as I am approaching 4 months?  I am more worried about the inconsistent texture from top that is softer and puffier over the hard bottom ridge.

Can a gland grow back this early and why does massage feel like it temporarily reduces the puffy swelling down to just the hard underneath tissue?
Any input is appreciated. Thanks a bunch!

[Dr. Elliot Jacobs]

Gland does not grow back quickly -- period!  You may be dealing with scar tissue, which varies with every patient and even from side to side on the same patient.  There may also be a component of residual swelling, which will respond quickly to massage or pressure -- only to return at some point.

Best is to keep in touch with your surgeon and follow his/her advice.  Alternatively, you can consult with another gyne expert for an additional opinion.

Good luck!

Dr Jacobs

[Fisher]

Thank you for the reply Dr Jacobs. It's good to hear that gland cannot grow back that quickly as this is my biggest fear. The troubling side continues to evolve daily in feeling, hardness and irregularities, but has stayed roughly the same size. I will see what my Dr says in June. 

I'm hoping it goes down on its own by then, but not getting my hopes up. Is it true peak scar tissue can be as late as 4 months, and then it starts getting better?  

Thanks again

[Dr. Elliot Jacobs]

Scar tissue growth usually starts around 4-6 weeks after surgery (extremely variable) and peaks around 3-4 months.  It then begins to soften but may never completely disappear.  And it can be different on both sides of the chest.

Dr Jacobs

[Fisher]

Thank you again for reply. 

Last question for anyone is new swelling normal? For the last few weeks the areola will swell up over night or sometimes within a few hours of sitting. Thirty seconds of massage flushes the fluids out, but I’m concerned since this didn’t happen the first 2.5 months. No pain. It looks like I was just injected fluids with a syringe. I do feel as if the scar tissue underneath is getting smaller. 

Sorry for all the questions. I see my doc again early May, but if I have question for him I have to ask a nurse over the phone then she relays the answer later. 

[Dr. Schuster]

Your story sounds as though there might have been a hematoma, or a collection of blood, that developed. This would cause early large sweling and can take months to resolve on its own, and could leave a "rim" that you describe. If you feel something that feels like a water bed than you might have a chronic seroma. if you just have some firm lumps at three months after surgery there is still good reason to think it will improve. I would ordinarily recommend deep tissue massage but you should check with your own surgeon. If the swelling was originally from a hematoma you coud even consider ultrasound treatmentbut it would cost you some money. Good luck.

[Fisher]

Thank you for the reply Dr Schuster. I’m thinking something happened in the beginning that might not have been caught. It’s the waiting game now. 

[Fisher]

I received a half diluted steroid injection on my right side today. Just curious, but does the doctor have to hit every piece of the scar tissue or could you hit quadrants and the steroid spreads a little over the 6 weeks and work on all the scar tissue? Or another way of asking is if the scar tissue is shaped like a quarter, can the doctor inject a few sections or does the entire perimeter and center have to be injected? 

Thanks again 

[Dr. Schuster]

Steroid injections don't spread out too much. But sometimes it is better to take a gradual approach to injecting the scar tissue. There are certainly some risks associated with steroid injections, such as discoloration and atrophy, if not done carefully.