Does scar tissue cause puffiness?

[latediagnosis]

Hi, I got surgery October 22nd with a respectable surgeon, everything ran smoothly however I still have a bit of scar tissue and its been 8 months. I only had gland excision and no liposuction as I'm reasnobly lean.

Now to be honest I'm only about 50% satisfied with my results, my nipples still go puffy whenever I get hot (baring in mind im 100% happy when my nipples are erect). My surgeon offered to do a free revision where she said she'll excise a little more gland and get rid of the scar tissue, however she thinks there might not be much gland left to excise especially on my left side. I trust my surgeon 100% however I'm not sure if I want to deal with the extra downtime/heartache again, my fitness is very important to me.

So my question to the surgeons is, can scar tissue cause puffiness when its hot - baring in mind my chest is 100% fine when im cold and erect. Or is it only actual breast tissue that causes puffiness?

[Jake]

It's been eight months, most likely it's not scar tissue that's causing the problem.  It may be contributing to it some, but it's probably residual gland.  

If your surgeon says she'll remove scar tissue, don't kid yourself, it will come back.  Cutting out scar tissue begets more scar tissue.  If she is willing to do a free revision AND excise some more gland, I'd do it.  But tell her to be safe and not take too much.  You don't want cratering.

If it bothers you still, I'd take the offer.  Go through the down time again and remember that scar tissue can take a year or two to heal.  Just be warned and listen to the surgeon when risks are explained.

[latediagnosis]

The problem is, I can definitely feel scar tissue - I mean there is no doubt in my mind there is scar tissue because there is solid bits right behind the the incision. So basically I need to know if scar tissue causes puffiness when hot or if its breast tissue only.

She did say removing scar tissue is usually pointless because it will just come back and the aim of the revision is to remove extra gland but shes not sure if there will be much/if any to remove, so you're spot on there.. Thats my concern that I will go through another surgery unnecessarily, although hopefully I can get less scar tissue this time - as I was mucking around with the football a little prematurely last time and I think one time when I stretched out for the ball it really unsettled the healing process..

[Jake]

I highly doubt scar tissue is the primary cause of the puffiness that remains.  It's most likely residual gland. 

Whether you go through surgery again or not is up to you.  Don't let my opinion be your basis for deciding.  You need to talk it out with your surgeon.  I wouldn't say the surgery would be "unnecessary" if she can still help you a little bit.  Especially since it's free, not a lot of guys get that second chance with their surgeon.

[i_dont_know]

Isn't there a medication that can be injected into the scar tissue site that can aid in breaking it up and dissolving it? I don't think having the scar tissue "removed" is a legitimate option (well, shouldn't be...) because the result is just going to be more scar tissue.

[Jake]

The scar tissue is most likely not his problem.  The amount of scar tissue is usually minimal anyways as it is just right behind the incision marks.

Kenalog injections have been said to work at reducing scar tissue.  It is basically just a cortisol shot that reduces inflammation in the body.  Some guys around here have tried it, although not much has ever been said about its effectiveness.

[Dr. Elliot Jacobs]

Jake  --  Kenalog injections will work -- if done properly in the right dosage, by the right "hands", etc.  In the few patients I have had who develop some scar tissue after surgery, the administration of kenalog substantially helps virtually 99% of the time.  In my opinion, if a patient develops scar tissue after surgery, and the surgeon is absolutely sure he has not left any gland behind, then kenalog injections and not additional surgery is the way to go.  Remember, additional surgery will remove the scar tissue -- only to be replaced by more scar tissue.

To answer the original question, I have never seen scar tissue cause a true puffy nipple.  I suspect you may have residual gland present -- but that should be checked with your original surgeon.

Dr Jacobs

[Dr. Elliot Jacobs]

Kenalog will only work on scar tissue -- not residual gland.  When I complete surgery on one of my patients, I am absolutely positive that I have removed all the excess gland.  Therefore, if one of my patients returns with seemingly increased tissue, then I can only surmise it is scar tissue and will then proceed with kenalog.

If a patient sees me after surgery by another surgeon, I cannot be sure if there is residual gland or newly developed scar tissue.  That is why I usually refer patients back to their original surgeon -- who should be in a better position to know whether there might be residual gland present.  If residual gland is suspected, then secondary surgery and not kenalog is the answer.

In general, if a patient was smooth, flat and contoured after surgery (and seemingly pleased with the results of surgery), and then develops some additional tissue (presumably scar tissue), then a try with kenalog might be indicated.

When this occurs in my patients, I do not charge for kenalog treatment -- it is included in my overall fee.  If it occurs in a patient of another surgeon, I would first recommend he return to the surgeon -- who may have his own fee structure for kenalog injections.  If he should want to see me for the injections, then my fee would be $250 per session.  Usually 1-3 sessions is all that is necessary for most patients -- and we space the treatments six or more weeks apart.

Like any medical treatment, kenalog injections should be performed by a physician who is experienced in its use.  If too much is injected -- or it is injected in the wrong layer, there can be over-correction and an actual depression created.

Dr Jacobs

[moobmaster]

dr jacobs, i have alot of scar tissue under my right nipple that is causing it to push out and looks like the gyno i had before..the left side is perfect..i just came back from Dr baxt's office (my surgeon)in paramus and he told me he never does kenelog shots and basically wrote me off saying it will all go away eventually...how would i set up kenelog shots with you...do i have to have a consultation first or can i come to your office, you evaluate me there and shoot me up right there on the spot...id hate to make more trips into the city than i have to....please PM me with this info

[Dr. Elliot Jacobs]

Yes, I should be able to take care of you and will send you a PM.

Dr Jacobs