I had gynecomastia surgery performed on July 30th and my left side of my chest is sunk in badly. (photos)

Question

Right side still very swollen. The surgeon was dr . Retson out of merriville indiana who is board certified plastic surgery with 28 years experience and is a hand surgery specialist. The left side of chest is not very swollen ,just sunk in badly. Gets worse when I flex the musle. I spoke to doctor about this and he told me I would have to get a fat transfer one visit another visit he said he could fix in office by numbing the area and cutting scar tissue away from skin? I'm very scared that I gave been cut up and messed up.

Jed H. Horowitz, MD, FACS · Answer

Bruising and swelling are normal and usually increase slightly after the removal of any tape or foam. The bruising will decrease over 3-4 weeks, but may last as long as 6 weeks. The majority of the swelling will be gone within the first 3-4 weeks. However it may take 6-9 weeks to disappear completely. The compression garment helps reduce the swelling, and the longer it is worn, the more quickly you will heal.

It is also normal to experience numbness around the areola and chest. As your body heals, you may notice random bursts of pain in your chest. This is usually a sign that the numbness is subsiding. As you heal, the area may feel “lumpy” and irregular. This, too, decreases with time, and massaging these areas will help soften the scar tissue. Given your feeling of sunken chest area there is likely still time to finish the healing process, but if you have questions or concerns it is good to visit your surgeon to have the healing process evaluated.

As with all operations, pain and discomfort varies greatly from patient to patient. Generally, one should expect that pain medication will be required for the first several days. Continuing discomfort can last varying amounts of time. Additional procedures that often enhance gynecomastia results are liposuction of the abdomen and flanks.

Nelson Castillo, MD · Answer

Thank you for sharing your question and I can understand your concern.  It is difficult to give you a definite opinion without an in-person evaluation of your chest tissues as there is a very large discrepancy in contour and shape/size to your two chests. For one a hematoma would need to be ruled out on your left side, as well as continued asymmetrical swelling.  Secondly, feeling the tissues would determine if you have residual gynecomastia tissue, fibrofatty tissue, or scar.  I would voice your concerns to your surgeon to have a treatment plant determined, but if unhappy with what you hear, seek out a second opinion from an ASPS board certified plastic surgeon.

Brian Arslanian, MD · Answer

I am sorry to hear about your complications.  Many people will probably tell you to sit back and wait.  I know that is hard, but in this field, a lot of things will change over time because of scarring and swelling.  We know from experience that many things that seem like problems, will improve on their own over time.  That will save you money, additional surgery and aggravation.  That being said, based on what I am seeing, I am a little concerned that the resection was too aggressive on the left side and you may very well need some fat grafting to even that out.  My advice would be to stay in good communication with your surgeon and follow their instructions.  If in 6 months you are not happy and he is not giving you the answers and responses you think you need, then consider getting a second opinion.  I hope this helps."The above answer has been given without seeing this patient and cannot be substituted for actual in-person examination and medical advice; it is only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Edward J. Ricciardelli, MD · Answer

Just to second the other surgeons that you should wait until the inflammation(i.e. Swelling tenderness and red scars) subsides.  Stick with it.  Your surgeon appears to be committed to you and to a nice result.  We all know it's tough to be patient but it will pay off in the end.

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after gynecomastia corrective surgery. Your plastic surgeon will always be your best resource when it comes to accurate assessment, advice, and/or meaningful reassurance.

Generally speaking, one of the potential risks associated with gynecomastia surgery is contour deformity related to over resection of glandular tissue and/or adipose tissue. This is a risk that is explained to patients who are undergoing the procedure. Many patients who have gynecomastia are looking for the chest to be as flat as possible. Surgeons must balance their desire to achieve the patient's goals with efforts to avoid over resection and contour deformity.

You may find that your situation will be improved upon release of scar tissue in addition to techniques such as fat grafting and use of allograft/dermis as a filler

I hope this helps.

Steven Wallach, MD · Answer

The situation you describe can occur and it sounds like your surgeon is offering reasonable solutions. Right now you have to give it time to heal. Best of luck.

Robert J. Paresi Jr., MD, MPH · Answer

Thanks for the question.  One of the most important aspects of gynecomastia excisional surgery is what tissue is left behind.  It is very important to leave 1-2 cm of breast and fatty tissue behind the nipple-areolar complex to prevent the sunken-in appearance.  I would wait three to six months before any secondary intervention to address any issues.  The appearance of the left chest is the result of a skeletonized pectoralis major muscle which is why it looks worse with flexing the muscle.

Samir Shureih, MD · Answer

Based on the pictures posted, there could be swelling or a major problem with too much fat and gland removed. Wait at least 3 months and then re-evaluate. Need in person examination to properly diagnose the problem and plan for treatment. May require multiple sessions of fat transfer to correct the problem, may require some liposuction to the parts of the chest that fat was not removed.

Marc J. Salzman, MD, FACS (retired) · Answer

Thank you for your question and I do appreciate your position. It's my recommendation, that he would wait several months until all of the inflammation and swelling has abated so you're not trying to  do fat grafting on top of scarring. After several months, you may then need a touchup with some fat grafts to help that depression. Best of luck.

David E. Berman, MD (retired) · Answer

It is difficult to be certain without seeing you in person. however, i would almost certainly wait 4-6 months before considering doing a fat transfer. I  had a  patient, who appeared sunken a few weeks after surgery and then over the course of a year, got better and better with each passing month, so that ultimately no treatment was required. also it looks like the lower half of your right areolar is black?you should get a second opinion if you are not comfortable with what your surgeon suggested.good luckdavid berman md

I had gynecomastia surgery performed on July 30th and my left side of my chest is sunk in badly. (photos)

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