Kenalog Shots for Scar Tssue

[ddrop]

Doc, i'm 6 weeks post-op now and it seems to me the scar tissue has peaked, there's alot of it and it's pretty damn hard. Is that normal at this time? When can i expect it to start decreasing? Thanks!

[ddrop]

And if i may ask. my surgeon didn't recommend any massage to me. so could you please help me out and tell me how to massage it? is there any special way?

[Dr. Elliot Jacobs]

The time frame of 4-8 weeks after surgery appears to be the time of maximum  firmness -- and this frequently occurs just under and immediately surrounding the nipples.  This is a combination of swelling plus early scar tissue and the first thing to do is NOT PANIC.  Second thing is to massage the area twice a day for at least 5-10 minutes.  Raise one arm behind your head and use the soft parts of the three middle fingers of the other arm for massage (lubricate with any skin cream).  Press and swirl the fingers over any firm areas.  Then switch arms and do the same on the other side.  Wearing the compression garment during this time frame is also important.

Time is the best healer in this situation.  I generally delay kenalog injections (which are potent and have potential for improvement or disaster) until a minimum of 4-6 months after surgery -- just to give your massage and Mother Nature a first opportunity to do it right.

Elliot Jacobs, MD, FACS

[ddrop]

Thanks doc!! Just so that i don't do anything wrong -swirling is a circulating spiraling motion?

[Dr. Elliot Jacobs]

Yes -- use a circular motion while pressing in firmly -- but back off somewhat if it is too tender.

Dr Jacobs

[ddrop]

You say that wearing the garment is very important. I've been wearing it for 4 weeks almost all of the time. And have combined the medical garment with the nike sports garment for 2 weeks. Would you recommend i continue this or not?

Btw, thanks for the massage advice, it seems to be helping slowly!

[Dr. Elliot Jacobs]

It is my opinion that the longer you can wear firm compression, the better and faster the healing will be.  That being said, I am aware that it is a colossal pain in the *** to wear it.  I generally ask my patients to wear it at least 3-4 weeks continuously after surgery and then switch to a more comfortable but no less tight garment such as an undersized Under Armour and the like.  Wearing a garment that is too loose is simply a waste of time -- don't even bother.

Dr Jacobs

[ddrop]

Oh,  i understand

Is there any time when the garment becomes more or less useless?
What is it actually for after 6 weeks?  So that the skin reshapes better, to reduce swelling or to reduce scar tissue?

[Dr. Elliot Jacobs]

I would guess after 6-8 weeks, the garment is not as important -- although you may find that after a workout, you are swollen and wearing the garment for a few hours will help bring down that swelling.

The garment initially help to limit swelling and helps the skin to tighten.  It's pressure also limits any tiny amount of bleeding that might occur after surgery.  As I tell my patients, after the actual surgery, wearing a tight compression garment is the most important thing that a patient can do -- and it is entirely under the patient's control.

Dr Jacobs

[ddrop]

Any chance i could somehow reduce the swelling at this point?

[Dr. Elliot Jacobs]

I really can't comment unless I had actually examined you.  However, I would recommend patience, patience, patience -- wait it out.  Sometimes the final result from gyne surgery can take 6-8 months or longer.  And during that time, it is not unusual for there to be intermittent swelling -- occasionally on one side and then it switches to the other.  Ultimately it settles down and there is no swelling.

Dr Jacobs

[ddrop]

Yeah,that's it, it's only on one side now. Thanks for the info again, i guess this is just a very tough waiting game!

[sadgyneguy]

I really can't comment unless I had actually examined you.  However, I would recommend patience, patience, patience -- wait it out.  Sometimes the final result from gyne surgery can take 6-8 months or longer.  And during that time, it is not unusual for there to be intermittent swelling -- occasionally on one side and then it switches to the other.  Ultimately it settles down and there is no swelling.

Dr Jacobs

its nice to hear that it takes that long i am 278 days post op. and i am still waiting for the swelling to come down... would you recommend this kenalog shots to anyone? i am interested to have one cause im tired of waiting...   

thanks

[Dr. Elliot Jacobs]

Only your last surgeon could assess at this time whether you have residual swelling, residual (un-removed) gland, or scar tissue.  Kenalog would only work on scar tissue.

Dr Jacobs

[ddrop]

I was wondering, since i am doing alot of weight lifting (medium) and swimming the past 2 weeks could this swelling be from this? And is this "good swelling" or should i stop or minimize the physical activity so that it would go away?