Gynecomastia revision - Can condition be caused by scar tissue and not breast tissue? How can I tell?

Question

I had a gynecomastia revision surgery recently. After the surgery, I was told that my condition is caused by mostly scar tissue from previous surgery, and not breast tissues. Nothing much can be done. 1. Is this true? 2. Are there any ways or scans that can differentiate between scar tissues and breast tissues?

Jon S. Wilensky, MD · Answer

Gynecomastia is a medical condition characterized by the enlargement of male breast tissue. It is usually caused by an imbalance in the hormones estrogen and testosterone, which can lead to the growth of excess breast tissue. While gynecomastia is typically associated with the proliferation of breast tissue, scar tissue can also play a role in certain cases.
Scar tissue can form as a result of surgery, injury, or other trauma to the chest area. In some instances, scar tissue can contract and create a tightening effect around the breast area, making it appear as though the breast tissue is enlarged. This condition is sometimes referred to as "pseudo-gynecomastia" or "false gynecomastia."
If you're concerned about whether your condition is primarily caused by scar tissue or actual breast tissue, here are some steps you can take:
1.) Consult a Medical Professional: It's important to consult a qualified medical professional, such as a plastic surgeon, endocrinologist, or general practitioner. They can perform a physical examination, review your medical history, and potentially order tests like hormone levels or imaging studies to determine the underlying cause of the enlargement.
2.) Imaging Studies: Imaging techniques such as ultrasound or mammography can help differentiate between breast tissue and scar tissue. These tests can provide a clearer picture of the composition of the tissue in the affected area.
3.) Symptoms: While both scar tissue and breast tissue can cause the appearance of an enlarged chest, gynecomastia caused by breast tissue may be associated with tenderness, pain, or sensitivity in the breast area. Scar tissue-related enlargement might not have these symptoms.
4.) Response to Treatment: The response to treatment can also provide clues. If the enlargement responds to hormonal treatments (like anti-estrogen medications), it's more likely to be true gynecomastia. If the enlargement remains unchanged despite such treatments, scar tissue might be a more plausible cause.
5.) Surgical Evaluation: If considering surgical intervention, consulting with a plastic surgeon experienced in gynecomastia correction is important. They can assess the tissue composition during the procedure and make appropriate decisions based on their findings.
Remember, only a medical professional can accurately diagnose the underlying cause of your condition. If you suspect gynecomastia or any related concerns, seeking medical advice is crucial to determine the appropriate course of action.

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment regarding the outcome of a plastic surgery procedure we always need to see proper before and after pictures. If someone has had more than one procedure than you should, ideally include before and after pictures for both procedures. If you don’t have proper before and after pictures then ask your surgeons to forward the pictures they took.
There are three tissue variables that determine what the male chest looks like. Each of these can contribute to fullness of the chest and generally a lack of results is always going to be related to one or more of these tissue variables.
The three tissue variables that contribute to the shape and contour of the Male chest are going to be potential skin laxity typically due to weight fluctuations or age, excess subcutaneous fat or glandular breast tissue.
Differentiating between the three tissue variables can be tricky, especially by those who lack sufficient skills and experience. Personally, I find it easiest to differentiate which tissue layer is contributing the most by putting the skin under tension. You can do that by stretching one arm at a time behind your head like you’re scratching the top of your back.
With one arm behind your neck, you’ll have your skin and pectoralis muscle under tension, and this changes, the contour of the chest dramatically. With the skin and pectoralis muscle under tension, you can fairly easily see the exact contour of any possible remaining breast, parenchyma, scar tissue, and subcutaneous fat. as you slowly put your arm down by your side, you can then see how much skin laxity is contributing to contour. 
Knowing your age and any history of significant weight fluctuations(even 20 to 30 pounds of weight change can cause skin issues) can’t help determine why your results look the way they do.
Most gynecomastia treatments entail excision of glandular tissue with liposuction of subcutaneous fat.
This should give excellent results on individuals with tight skin, whose nipple position is an appropriate place.
Individuals with even mild skin laxity will see a loss of ideal contour with the arm down by the side, and significant improvement while the skin is under tension.
The ability to make a proper assessment regarding the Male chest, will vary substantially among plastic surgeons.
Simply making an accurate assessment and being able to decipher which tissue layer is causing a lack of ideal outcome after surgery is not always straight forward.
Generally, speaking, men should expect moderate improvement, but it’s important to recognize your candidacy for the procedure, and this must take each of the three tissue variables into consideration.
Men with significant skin laxity are not going to have favorable outcomes, unless the skin laxity is addressed, which is not a simple thing to do it from a surgical perspective.
Best,
Mats Hagstrom, MD

Gynecomastia revision - Can condition be caused by scar tissue and not breast tissue? How can I tell?

Answers (2)

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