Kenalog - question

[cowboy100]

I have a question for the experts or anyone who may have read or used kenalog on here. I have some scar tissue under various areas of my nipples and chest, I plan to get a kenalog shot to help this out this month. What I am wondering is 2 things. First if the Kenalog is for instance injected not directly into the chunk of scar tissue will it still break it down like if it was injected right beside it because it may be hard for my surgeon to hit a small piece of scar tissue directly on especially if there is fat around it and such. Secondly if the scar tissue is not just one chuck but a few small pieces how is the best way to handle this ... for example on my left side there is a chuck under my nipple and a bit right below the nipple. Should I ask he injects a bit in one spot and a bit in the other? Any info on kenalog would be great! thanks 

[Dr. Elliot Jacobs]

If scar tissue develops after surgery, it is usually in one solid area -- not scattered across the breast. For optimal effect, the kenalog should be injected directly into that scar tissue.  Make sure your doctor is able to do this.

Dr Jacobs

[DrBermant]

I have a question for the experts or anyone who may have read or used kenalog on here. I have some scar tissue under various areas of my nipples and chest, I plan to get a kenalog shot to help this out this month. What I am wondering is 2 things. First if the Kenalog is for instance injected not directly into the chunk of scar tissue will it still break it down like if it was injected right beside it because it may be hard for my surgeon to hit a small piece of scar tissue directly on especially if there is fat around it and such. Secondly if the scar tissue is not just one chuck but a few small pieces how is the best way to handle this ... for example on my left side there is a chuck under my nipple and a bit right below the nipple. Should I ask he injects a bit in one spot and a bit in the other? Any info on kenalog would be great! thanks 

Kenalog works on scars in the site it was injected but will not soften remaining gland. Scars after gynecomastia surgery can involve the surface skin or deeper structures. Such scars can be localized or extensive. Check out these extended adhesion scars Video Male Chest Scars, especially on flexing the chest muscles. For the skin to move in a natural fashion, it needs a "lubrication" layer of fat between it and the deeper structures. Steroid injections can soften scars, but will not replace the missing fat. Injections will not fill in Crater Deformity Defects from Bad Gynecomastia Surgery. I have seen patients with badly injured tissues from certain liposuction techniques that almost the entire chest was adherent to the deeper tissues. I just operated on another liposuction only patient who had such extensive scars that he had a low nipple, severe skin crease, and extensive internal scars.

That is why checking how tissues move can be so critical to evaluate a particular doctor's surgical technique. For something to look good, it should also look good why performing activities such as flexing muscles or raising arms up overhead.

Options depend on the original problem, what was done, how someone scars, and many other factors best explored during a consultation. When tissue is available I have found my Fat Flap Technique an awesome tool to release such scars, leave a layer of fat, and provide a result that moves normally.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

[Dr. Elliot Jacobs]

I have some scar tissue under various areas of my nipples and chest, I plan to get a kenalog shot to help this out this month.

How long are you after surgery??

Usually, I would wait at least 4-6 months before considering kenalog injections -- and sometimes they may not be necessary at all.  If you are less than 6 months, you might try a program of massage -- and observation.  Oftentimes some of these issues will resolve themselves -- without the need for kenalog.

If indeed you do have a buildup of scar tissue beneath the nipples, then carefully done kenalog injections can minimize the possibility of a crater deformity. 

Fat flaps, a commonly utilized technique by all plastic surgeons, would require another operation -- and I sense that is not exactly what you would like to have done.

Dr Jacobs

[cowboy100]

I had surgery 3 years ago and revision 2 years ago...already had a small dose of kenalog aswell. basically I feel like hard areas of chunks of something in 1-2 areas around and under my nipple. If this is some gland remaining or rebuilding should I maybe take tamoxifen, and if its scar tissue I assume kenalog would be best. My nipples are ok when relaxed but when moving or when its cold they are just really pointy and the the area around them sticks out a bit too

just a little back story for the first year after my surgery my chest was great the it started pocking out a bit again so I had revision...they were fairly flat again and the doctor said he just removed scar tissue...few months later poked out a bit again so I had a little kenalog to the one side, then later my nipples were so pointy I had nipple reduction surgery. look good for a bit but I think it was because they were numb from the freeze solution using in the reduction surgery and now they are a problem again and I feel some small hard chunks in a few areas mainly directly under the nipple and below the nipple on the left side.

[Dr. Elliot Jacobs]

Your story is a bit unusual.  If your surgeon did a revision and took out scar tissue ( I assume it was sent to a lab to prove the point), then it is unlikely that you will be re-growing gland tissue.

The problem with revision surgery to remove scar tissue is that you will heal with more scar tissue.  That is why, at least with my patients in whom I know I removed the excess gland tissue, I will only treat with kenalog -- and sometimes several injections over time -- to manage any scar tissue which may develop.

I think you should sit down with your surgeon and review the entire scenario and try to decide what would be the best course of action.

Dr Jacobs

[cowboy100]

Thanks a lot for your replys, I have been posting like crazy ever since I got back from the nipple reduction about 5 weeks ago cause it looks almost worse now. I feel like it looks less flat by the day and I don't know if that is because I am working out and it is revealing it or if gland is beginning to grow. Also I don't think and lab work was done to prove it was just scar tissue he removed but that Im unsure of of it just seem that after about a year both time my chest started to puff out again, and my PS has kinda suggested fthat that is how my chest is and that there is not a lot of hard masses under my chest, there is a bit though. I also feel like when its gland thats there your chest looks good when its cold and poor when warm, mine is now the opposite. Then its warm its a bit puffy but looks ok, when its cold my nipples are super pointy and the areora (area around the nipple, forget the name) pushed out more aswell 

[DrBermant]

Thanks a lot for your replys, I have been posting like crazy ever since I got back from the nipple reduction about 5 weeks ago cause it looks almost worse now. I feel like it looks less flat by the day and I don't know if that is because I am working out and it is revealing it or if gland is beginning to grow. Also I don't think and lab work was done to prove it was just scar tissue he removed but that Im unsure of of it just seem that after about a year both time my chest started to puff out again, and my PS has kinda suggested fthat that is how my chest is and that there is not a lot of hard masses under my chest, there is a bit though. I also feel like when its gland thats there your chest looks good when its cold and poor when warm, mine is now the opposite. Then its warm its a bit puffy but looks ok, when its cold my nipples are super pointy and the areora (area around the nipple, forget the name) pushed out more aswell 

For some there are multiple component to the contour problem.

There is a Thin muscle under the skin that when stimulated flattens most men's niples. Some men are the opposite. When this muscle is stimulated, the nipple protrudes, sticks out more. When it relaxes, it flattens. For this group of men, surgery does not manage the contour problem of nipple stimulation. After surgery, the muscle nerves can be paralyzed for a time. While not working, the results may look good until the nerves start working. It is not practical to knock out these nerves permanently. Steroid injections will not manage this normal function which is to get the nipple projected for breast feeding. (Useful for women, no reasonable function for men.) Someone claiming they have a cure for this problem should be able to demonstrate before and after photographs both stimulated and relaxed. Movies would be even better!

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

[cowboy100]

Yah I think that may be correct for me, although before I ever had surgery it was always my nipples looks odd and puffy when warm and relaxed and more normal when cold, I do think your right, but I think they protrude MORE then normal because of the extra scar tissue which it why I plan to do kenalog, plus there is a huge chump of something right below but not underneath my nipple which drives me nuts and I need to message it and move it around all the time.

[DrBermant]

Yah I think that may be correct for me, although before I ever had surgery it was always my nipples looks odd and puffy when warm and relaxed and more normal when cold, I do think your right, but I think they protrude MORE then normal because of the extra scar tissue which it why I plan to do kenalog, plus there is a huge chump of something right below but not underneath my nipple which drives me nuts and I need to message it and move it around all the time.

Yes, there can be more than one component causing contour concerns. Realistic Expectations is key to satisfaction after surgery.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[cowboy100]

So almost for sure I have the muscle issue where they are the opposite...flatten when relaxed, pointy when stimulated. But I can also feel these clumps which are obviously on top of the muscle, therefore I'm thinking I can at least marginalize my problem by reducing the scar tissue. Also my chest was flat for about 6-8 months afetr the first surgery and like 4-6 months after revision so I think there is hope for it to be flat if I can just really reduce the scar tissue.

[kbob]

If you have the same issue that I have then your nipples might now be protruding when cold because there is no adequate underlying structure under your nipple to attach to. When there is only very little layer of fat left after the surgery, the areola does not properly attach to the underlying tissue and when the little areola muscle contracts it pulls the areola together which raises it. No amount of Kenalog, or revision surgeries will fix that unless they address the consistent areola attachment to the underlying tissues.
My nipples were also pre-surgery slightly puffy, improved when contracted/cold. Post surgery this totally changed. They look fairly flat when relaxed, but crazy pointy (almost painfully shriveled up) when cold.
Could any of the Doctors comment on this issue?

[cowboy100]

 ^^^that is the exact problem I have, what can fix this?

[kbob]

It would be helpful if you can post photos. How much fat do you have between your areola and the chest muscle? Did you wear compression after the surgery? Are both sides behaving the same.

[cowboy100]

both sides same problem, I wore compression after surgery, did everything I was suppose to do. one side is a bit worse like if I need to I will post pics but I'm gunna wait a month cause I just got kenalog. Its pretty simple both sides of very sensitive and overly pointy when not relaxed like I feel the need to have the end of my nipple chopped off. The left side has this extra problem were the area around the nipple pushes out a bit when not relaxed to and kind of looks like "bubble gum nipple" all chewed up. Sound pretty similar to the post from above. And not alot of fat between.