question for dr.bermant

[%$#@!]

hey dr.bermant i had a question,do you treat your patients with kenalog shot if needed,i had surgery over seven months ago,and spring/summertime is coming up in a few month,but it seems like i still have what feels like gland or scar tissue not really sure, and my nipples are pointy when i wear just a plain t-shirt.i really want this problem gone by spring time this year so i can enjoy going shirtless to the beach,so i was wondering if it is scar tissue can you treat it with kenalog shots or will i have to go to dr.jacobs because he says he does treat his patients with them.anyway please comment here and let me know.thanks.

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and also the scar on my right side is kinda raised up and really noticable,would i have to get a revision or can it be treated otherwise.

[DrBermant]

hey dr.bermant i had a question,do you treat your patients with kenalog shot if needed,i had surgery over seven months ago,and spring/summertime is coming up in a few month,but it seems like i still have what feels like gland or scar tissue not really sure, and my nipples are pointy when i wear just a plain t-shirt.i really want this problem gone by spring time this year so i can enjoy going shirtless to the beach,so i was wondering if it is scar tissue can you treat it with kenalog shots or will i have to go to dr.jacobs because he says he does treat his patients with them.anyway please comment here and let me know.thanks.

For some traumatic techniques, steroid injections can sometimes compensate for some scar tissue, but not for residual gland.

I prefer to minimize the need for Kenalog injections with surgical techniques, targeting gland first, after surgery care, scar care, and other methods. When all of that fails, which for my patients is rarely, then kenalog injections may be an option for a surface scar component. I do not remember of a single gynecomastia patient scar on my website needed such injections for my surgery. Some of the patients seeking my help for revision surgery did try such injections with their prior surgeons.  Kenalog is not an alternative to residual gland, poor surgical technique, or poor choice of bad scarring patients for elective surgery.

Pointed nipples are a common complaint of those with too much gland left behind.  Standard After Gynecomastia Surgery Pictures or Standard After Gynecomastia Movies can help others better understand your concerns.

I do see many patients who are not happy with what their surgeons have left behind.
For these patients who do not like the scar / gland left gland behind, Revision Gynecomastia Chest Sculpture may be an option.

Here is an example of Revision Surgery for Puffy Nipples after Liposuction alone.   

Here is another revision after liposuction alone.

Here is another example to revise residual gland / scar after gynecomastia surgery done by another surgeon. See how this firmer tissue moves. Listen to this patient's experiences with his first and then revision operations.

Then look at the Before and After Revision Gynecomastia Surgery Pictures and particularly look at the gland left behind by the other doctor. This firm tissue, like a firm fat graft, just does not move well and left a puffy nipple deformity that made the patient unhappy with his other doctor's surgery.

There are other examples on the site, and I will probably be adding more.  We are glad to help patients explore their options during a consultation or a Preliminary Remote Discussion.  If interested in learning more, Jane is my office manager.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.

Hope this helps,

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

[DrBermant]

my chest wasnt flat,it was really pointy,anyway i just had a question,when i pinch the nipple area its kinda sore(not really pain or anything),i dont know if its scar tissue or what,when i talked to my doc he said he left behind enough so it wouldnt crater but its still not flat,especially when flexing my chest,my body fat is around 15% and i wanna drop down to single digits for summer but feel like its gonna make the chest area look worse,i dont even know what to do now especially cause the doc says it looks normal which i know it doesnt.i can try to get some pics up soon.

Sore and discomfort can be signs of injured nerves or one of the many Symptoms of Gynecomastia Gland under stimulation. I have also seen tenderness as a result of constant trauma from men trying to flatten their nipples by stimulating their areola skin muscle.

Fat loss can further unmask residual gland or scar tissue. While weight loss before surgery is often best, reconstruction surgery sometimes is an exception.  Excessive fat loss can limit my reconstructive options using local fat to fill in a deformity.  If steroid are tried such as kenalog, revision surgery should wait until the effects of the steroid have dissipated.

Hope this helps,

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

[%$#@!]

so if someone who had surgery doesnt know if its scar tissue or if its gland,how do you determine weather or not kenalog shots are right for them.and what would happen if you use kenalog shots thinking its scar tissue,but its really just gland,would it just not do anything or could it make the problem worse? what would be the cost of getting kenalog shots?

[DrBermant]

so if someone who had surgery doesnt know if its scar tissue or if its gland,how do you determine weather or not kenalog shots are right for them.and what would happen if you use kenalog shots thinking its scar tissue,but its really just gland,would it just not do anything or could it make the problem worse? what would be the cost of getting kenalog shots?

I use what any good doctor does, getting a good history, reviewing documentation as to what was done, clinical examination, and my experience. Since I have been seeing patients unhappy from other doctors' surgery for so many years, there have been quite a few repeat "offenders, " doctors who use a certain method that I have seen unhappy patients from before.

Kenalog as with all long lasting intradermal steroids can thin out normal tissue making a mess to work with. I have had to include removing surface components other doctors made too thin with steroid injections trying to treat a problem with the wrong solution. Such steroids can also impair local healing requiring a waiting period after the injection, before further surgery should be done.

Jane is my office manager and can better discuss our fees and costs.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.  However, you also need to include in cost calculations travel to the doctor, a consultation, and the extended wait until the revision surgery should take place.

Some doctors seem to need Kenalog and such steroids for many of their patients. I prefer techniques that makes such use quite rare in my practice. When excessive scarring is caused by a surgical technique, why keep using that method?  If I can damage tissue less that such injections are needed less, I rather evolve my technique than make patients travel long distances to come back for scar injections.

Hope this helps,

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