Concerns at two months post-op

[ChestBoi]

Hello Doctors,

First: I know it's been said before, but this forum is a veritable treasure trove of information thanks to your tireless efforts. The fact that you're willing to come here and provide free advice is a testament to the dedication you all have to your craft and to helping us all in our struggle with gynecomastia. It's heart-warming and honestly inspirational. I only wish there was something I could give in return besides my thanks.

Now, I'm posting today with some concerns.

I'll preface by saying that I have a follow-up with my surgeon in just under a month where I will be asking these questions as well. I'm asking here because I'm very anxious about the unknown.

Two months ago I underwent bilateral excision of gland, as well as vaser liposuction and bodytite skin tightening. I have attached pre-op and current photos.

I'm... moderately satisfied with my result. I had a huge pair of problems hanging off my chest pre-op (palm-sized glands!) and I understand that I may have to settle for improvement rather than perfection.

I also realise that two months may be quite early to judge. Still, I'm posting here as it seems that many start to see their final result at this stage.

All said, I have two main concerns:

• Creasing across my areolae
• Possible cratering under my areolae

Regarding the creasing, I understand that if this isn't caused by any cratering, it could be a result of skin laxity.

And as for the possible cratering, I understand that sometimes swelling/scar tissue can give the impression of a crater. I can feel a firm mass on my right side around the areola, and a smaller mass above my left areola. There's a definite "hollow" under the areolae when compared to the surrounding tissue, but it's hard to say whether this is due to the aforementioned scar tissue/swelling.

I don't think there's any adhesion as I can pull the areola out with little resistance.

I somewhat regret not discovering this website before my surgery, as it seems you all unanimously agree that surgery should be carried out at the patient's ideal body weight. I've struggled with weight loss over the past year (I'm shooting for 180lbs, currently 218lbs down from 240lbs). I would've heeded this advice had I seen it.

During consultation I queried weight loss with my own surgeon, who is regarded as one of the best in the UK and specialises in gynecomastia surgery, and he told me that it's not a major factor and that he operates on patients at all stages of their weight loss journey. While he is definitely an expert, I can't help but feel that the final result will be worse due to the fact that I got the surgery while still quite heavy.

The good news is that this surgery has spurred me to double my efforts with weight loss. Where I previously struggled with losing weight, I'm now determined almost to the point of zealotry. I've lost 17lbs since my surgery and anticipate that I will reach my 180lb target by May. Silver lining, I suppose.

I appreciate that you may not be able to answer any questions with certainty (or at all), but here they are:

• Based on the photos and my observations regarding the firm swelling/scar tissue, could there be any improvement to this cratering/creasing?
• Could weight loss improve my result?
• Could kenalog/similar improve this?
• Should I wait for 12 months (or more) to allow for any skin tightening? While the consensus here seems to be 6 months for a final result, literature and anecdotes surrounding post-weight loss skin laxity suggest that skin can take up to two years to fully tighten.
• Let's assume this is my final result and I have to go back for a revision (thankfully free of charge in most cases). Given the size of my prior gynecomastia, should I be satisfied with this result? Could I be chasing perfection and additional risk by getting a revision?

Apologies for the wordy post... many thanks in advance for any responses.

[ChestBoi]

Adding more photos inc. pre-op.

I can take better photos if needed.

[Dr. Cruise]

For starters, congratulations on taking the necessary steps to relieve yourself of your gynecomastia! That is a huge step. Your chest looks much improved. And, that is terrific that having surgery has motivated you to start your journey to losing weight and living a healthier lifestyle. 

Yes, it is true that is most cases it's best to wait 6 months+ to see the final result. If there is a continued issue with the nipple inversion, as you stated, this can be corrected by your surgeon for no charge. This will be a minor correction so that is good news. Your surgeon will advise you as to what he/she thinks can be done to improve the areolas. 

We look forward to hearing more about your progressions through the recovery period. 

[ChestBoi]

For starters, congratulations on taking the necessary steps to relieve yourself of your gynecomastia! That is a huge step. Your chest looks much improved. And, that is terrific that having surgery has motivated you to start your journey to losing weight and living a healthier lifestyle.

Yes, it is true that is most cases it's best to wait 6 months+ to see the final result. If there is a continued issue with the nipple inversion, as you stated, this can be corrected by your surgeon for no charge. This will be a minor correction so that is good news. Your surgeon will advise you as to what he/she thinks can be done to improve the areolas.

We look forward to hearing more about your progressions through the recovery period.

Thanks a lot for the response and the reassurance, Dr. Cruise. It really does help with the post-op anxiety.