Question for Dr. Jacobs or Dr. Bermant?

[jencplvr]

I had surgery on Feb. 25.. as of now, I am unhappy with the results.  Before the surgery, my chest looked similar as to what it does now.  However, the composition, for lack of a better word, is different.  When my arms are by my side, my chest still appears to have the 'pointy' shape that it did prior to my surgery.  However, when I squeeze or rub my chest, it feels a lot firmer around the surgical spots than it used to.  Before, it felt like mostly fatty tissue that I could move all around (However, my surgeon said it was a mix of fat and gland).  Now, it's pretty hard all around the nipple.  When I lift my arms over my head, there is a noticeable protrusion that looks almost oblong and is most noticeable on the left side.  I can't tell if it's just a large swollen area, scar tissue or possibly left over gland.. However, if it is gland, it didn't feel this way before the surgery.

  Also, my surgeon used drains and the area around the location of where the drains were still feels swollen.  At the time I took the drains out, I think it was too soon.. my left side was VERY swollen after removing the drains while the right side was a bit less.  I put gauze and bandages over the sites where I removed the drains initially... then, a couple of days later when the swelling was at it's peak, I was in shower and accidentally rubbed too hard on the areas where the drains were.. the left side started bleeding and it bled straight for almost a day and a half.. It wasn't a large amount of bleeding but it was a definite stream.  I kept applying new gauze and allowed it to continue.. After it finally stopped, I noticed the swelling had gone down some in the left side, which led me to believe that there was some blood trapped inside that needed to come out.

My biggest question now is... Does this sound like a hematoma has developed?

I realize that this could all be attributed to swelling and that I should give it more time, but I am concerned that this is something that will not just go away on it's own?  At this point, I will still not be removing my shirt if this does not change.

[Dr. Elliot Jacobs]

Many of your concerns are difficult to address without actually examining you.  Those concerns, therefore, should be addressed to your surgeon.

As for the continued bleeding after surgery, it does sound like a hematoma, but you should absolutely return to your surgeon ASAP for him to evaluate it. It is possible that he may have to drain it -- but please do see him quickly.

Good luck to you!

Dr Jacobs

[jencplvr]

Thanks for your quick reply!

I understand that I should probably make a move on this quickly, however.... I had my surgery done out-of-state and can't just drive there to have this looked at. Can I go to a general practioner to have this assessed and taken care of?  Or do I need to go back to my surgeon?  The earliest I can get back there is in two friday's from now.. that is exactly one month after the date of my surgery.

[Dr. Elliot Jacobs]

If you are concerned about a possible hematoma, then it should be checked by a doctor sooner rather than later.  Since you went to an out of town surgeon, any doctor (even a GP) is better than none at all.  If you GP feels there is something that must be done soon, he can then refer you to a surgeon in your local area for treatment.

Dr Jacobs

[DrBermant]

I had surgery on Feb. 25.. as of now, I am unhappy with the results.  Before the surgery, my chest looked similar as to what it does now.  However, the composition, for lack of a better word, is different.  When my arms are by my side, my chest still appears to have the 'pointy' shape that it did prior to my surgery.  However, when I squeeze or rub my chest, it feels a lot firmer around the surgical spots than it used to.  Before, it felt like mostly fatty tissue that I could move all around (However, my surgeon said it was a mix of fat and gland).  Now, it's pretty hard all around the nipple.  When I lift my arms over my head, there is a noticeable protrusion that looks almost oblong and is most noticeable on the left side.  I can't tell if it's just a large swollen area, scar tissue or possibly left over gland.. However, if it is gland, it didn't feel this way before the surgery.

  Also, my surgeon used drains and the area around the location of where the drains were still feels swollen.  At the time I took the drains out, I think it was too soon.. my left side was VERY swollen after removing the drains while the right side was a bit less.  I put gauze and bandages over the sites where I removed the drains initially... then, a couple of days later when the swelling was at it's peak, I was in shower and accidentally rubbed too hard on the areas where the drains were.. the left side started bleeding and it bled straight for almost a day and a half.. It wasn't a large amount of bleeding but it was a definite stream.  I kept applying new gauze and allowed it to continue.. After it finally stopped, I noticed the swelling had gone down some in the left side, which led me to believe that there was some blood trapped inside that needed to come out.

My biggest question now is... Does this sound like a hematoma has developed?

I realize that this could all be attributed to swelling and that I should give it more time, but I am concerned that this is something that will not just go away on it's own?  At this point, I will still not be removing my shirt if this does not change.

A Hematoma After Gynecomastia Surgery is a complication that can happen to any experienced surgeon. Clotted blood tends to not want to come out through a drain until it liquefies or softens. This can take a few days after the bleeding. Once a hematoma has drained, the tissue can remain swollen much longer than a surgical site that did not suffer such a complication.

I understand that I should probably make a move on this quickly, however.... I had my surgery done out-of-state and can't just drive there to have this looked at. Can I go to a general practioner to have this assessed and taken care of?  Or do I need to go back to my surgeon?  The earliest I can get back there is in two friday's from now.. that is exactly one month after the date of my surgery.

Hematoma are very rare in my practice. Each patient in my practice is checked before they travel home to to make sure. I have never had a hematoma develop after a patient left Virginia. Have you discussed this with your doctor? I certainly would be disappointed if one of my patients did not call me immediately with such a concern. That way your doctor can help you decide the best course of action.

Hope this helps,

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