Is kenalog recommended?

[AZ54321]

Hi, I had surgery with Fielding about 5 months ago and my results are no where near what I wanted them to be. You can see my recent post in this same forum for more details on that, but since I have a little bit of a different question, I've decided to make a new post. First, do the surgeons here recommend using a kenalog shot if my own PS says that my problem is scar tissue? I've been massaging for nearly 1.5 months and there's been no improvement. Would it be better for me to just leave my chest as it is, and go for a revision possibly with another surgeon instead of risking any complications that may arise from a kenalog shot? And my other question: have any guys here experienced luck with a kenalog shot after surgery to cure their residual puffy nipple? I'm really afraid that now if I get a kenalog shot im gonna have a crater deformity... thanks

[Dr. Elliot Jacobs]

I can't comment on your own particular situation without benefit of a hands-on physical exam.

But in general, kenalog does work on scar tissue.  Obviously, the doctor who injects it must be experienced in its use.  And as with any treatment, one is better to be conservative rather than overly aggressive.  In essence, treat slowly and carefully and "work" the tissue down slowly.  If done properly, you should not create a crater deformity.

The problem with "revision" surgery to remove scar tissue is 1) it is difficult, and 2) what is to prevent new scar tissue from forming again?  That is why I am an avid supporter of kenalog for appropriate cases.

Dr Jacobs

[DrBermant]

Hi, I had surgery with Fielding about 5 months ago and my results are no where near what I wanted them to be. You can see my recent post in this same forum for more details on that, but since I have a little bit of a different question, I've decided to make a new post. First, do the surgeons here recommend using a kenalog shot if my own PS says that my problem is scar tissue? I've been massaging for nearly 1.5 months and there's been no improvement. Would it be better for me to just leave my chest as it is, and go for a revision possibly with another surgeon instead of risking any complications that may arise from a kenalog shot? And my other question: have any guys here experienced luck with a kenalog shot after surgery to cure their residual puffy nipple? I'm really afraid that now if I get a kenalog shot im gonna have a crater deformity... thanks

Advice is best from a doctor who is familiar with the specifics of the problem. That is normally the original surgeon or someone a patient sees for a second opinion. Tissues can take 6 months or longer to evolve after surgery.  Puffy nipples after gynecomastia surgery can mean different things to different people. That is why I designed Standard After Gynecomastia Surgery Pictures and Standard Video after Male Breast Reduction to better help document issues. Posting such photos or video could help others better understand your concerns.

It has been quite some time since I needed to use Kenalog for one of my patient's scars. I prefer surgical techniques that emphasize careful sculpture of the tissues, after surgery care, After Surgery Compression, and Scar Care. Some doctors seem to recommend or use this medication quite a bit more.  That may be fine for patients who are close by, but many years ago my practice evolved to one where patients have been traveling from around the world to see me. I therefore migrated to techniques that helped minimize travel back to Virginia.

Kenalog will not help with gland left behind. Here are several examples where I would not have used or other doctors tried to use such steroids but injections did not work.

• Puffy Nipples after Liposuction Alone
• Revision Puffy Nipples after liposuction alone
• Residual Tissue and  Gland after Gynecomastia Surgery
• Puffed Nipples after Gynecomastia Surgery

Take a look at what I removed for each of these situations.  Those glandular masses will not be managed by Kenalog injections. Kenalog will not help with Crater Deformities and Depressions After Gynecomastia Surgery. Injection of steroids into normal tissues can thin them making a mess.

Judgment about any one specific situation is best reserved for a careful investigation as to the original problem, what was done, and examination (usually in person since such issues are best evaluated in person).

Hope this helps,

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

[AZ54321]

I understand it's a matter of trusting my own surgeon, but how can he tell if it's gland or scar tissue to make the appropriate decision? He told me that after I massage my chest, the size of my puffy nipple will go down immediately (and this happens). Does this mean that it's just my areola muscles contracting and giving a false impression of a better contour? If it makes any difference, when i do try to massage the hard parts under my areola, the skin on my areola doesn't "shrivel" up like it used to pre op -- my areola's gets pretty much flat and is smooth, not like the skin of a raisin (sounds kinda funny, eh?). Is this a good sign, or does it not make a difference? What's actually being done to the scar tissue during massage? Thanks again.

[DrBermant]

I understand it's a matter of trusting my own surgeon, but how can he tell if it's gland or scar tissue to make the appropriate decision? He told me that after I massage my chest, the size of my puffy nipple will go down immediately (and this happens). Does this mean that it's just my areola muscles contracting and giving a false impression of a better contour? If it makes any difference, when i do try to massage the hard parts under my areola, the skin on my areola doesn't "shrivel" up like it used to pre op -- my areola's gets pretty much flat and is smooth, not like the skin of a raisin (sounds kinda funny, eh?). Is this a good sign, or does it not make a difference? What's actually being done to the scar tissue during massage? Thanks again.

After surgery pressure and massaging attempt to influence how the body manages the remodeling of injured tissues.

After Surgery Scar Care is not immediate, it takes time to influence how scars evolves. There is a thin muscle just under the nipple areola, that when stimulated will Flatten Puffy Nipples. This muscle can be stimulated by massaging. The effects of this muscle's hiding the underlying contour, however, are temporary. When the muscle relaxes, the underlying contour will again show through.

Hope this helps,

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