Chest asymmetry after gynecomastia surgery?

Question

A 23yo asian male who underwent gynocomastia surgery 11 mo ago, left nipple looks a little bit more puffier than right and i feel like there is some residual gland or scar tissue?I need input. Will appreciate the help. Thanks.

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question here.let me start by stating that my answer is based on the limited information provided , for a more detailed/bespoke plan please consult with your plastic surgeon.
I am sorry to hear that you are not pleased with the outcome , you are close to the year mark which is when you can see your final result , without an exam it is hard for me to weigh in on what tissue is causing the issue you are mentioning . for the most part most surgeons leave a small amount of gland as not to cause a deformity ( if you take the whole thing your nipple/areola loses support , sinks in and might scar to underlying tissue and muscle). So the surgeon could have left more gland on one side vs the other or you could have also redeveloped gynecomastia again in the remaining gland if the original cause of gynecomastia wasn't addressed , and if that is the case your surgeon might want to obtain a hormonal profile etc. On the other hand if liposuction was used and more fat was taken from one side vs the other , then a simple revision with liposuction will usually do the trick. In any case should your surgeon deem it appropriate a revision surgery can take care of the issue.
I hope this helps, Best of luck!

James Knoetgen, III, MD · Answer

Experiencing asymmetry after gynecomastia surgery is not uncommon, especially if it’s been 11 months since your procedure. Here are some potential causes and next steps:
Potential Causes of Asymmetry:
1.	Residual Glandular Tissue
o	If some gland tissue was not fully removed, it may leave a slightly puffy appearance. This can sometimes happen because the goal is to avoid over-resection, which could create a hollow or unnatural look.
2.	Scar Tissue or Fibrosis
o	Internal scar tissue can feel firm under the nipple and may contribute to unevenness or puffiness.
3.	Post-Surgical Swelling (Seroma)
o	Although swelling usually resolves within a few months, seromas (fluid pockets) or late-onset swelling can occur, causing asymmetry.
4.	Natural Asymmetry
o	Even with surgery, no two sides of the chest are perfectly symmetrical, and small differences may be more noticeable after the procedure.
5.	Hypertrophic Scarring or Keloid Formation
o	Some patients, especially those with darker skin tones, may develop raised scarring around the incision sites, contributing to a puffy look.
What You Can Do:
1.	Wait and Monitor
o	At 11 months post-op, scar tissue may still be remodeling. In some cases, it can take up to a year or longer for final results to become fully visible. If it’s improving gradually, continue monitoring.
2.	Massage and Steroid Injections
o	If it’s scar tissue, your surgeon may recommend scar massage to break down the tissue. Corticosteroid injections (like Kenalog) can also reduce puffiness caused by hypertrophic scars or fibrosis.
3.	Ultrasound or MRI
o	To confirm if there is residual gland tissue, you could consult with your surgeon about doing an ultrasound or MRI of the chest.
4.	Revision Surgery
o	If residual gland tissue is confirmed and it’s bothersome, revision surgery might be an option to remove it. Surgeons typically recommend waiting at least 12-18 months before considering revisions.
5.	Follow-Up with Your Surgeon
o	Schedule a follow-up consultation to discuss your concerns. They can evaluate whether it’s scar tissue, swelling, or residual gland and recommend the best course of action.
 It’s not uncommon to have minor asymmetries post-surgery, but if it bothers you, a follow-up with your surgeon is the best step. They may suggest non-surgical treatments first (like massage or steroids), but revision surgery remains an option if the issue doesn’t improve.

Mats Hagstrom, MD (license on probation) · Answer

In the assessment of the Male chest weather before or after surgery, there are three Tissue variables that need to be assessed, these are excess angular, tissue, excess subcutaneous, fat, and skin laxity.
To make a quality assessment regarding the outcome of any plastic surgery procedure we need to see quality before and after pictures.
If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took.
It looks like skin without significant skin laxity.
 to differentiate potential impacts of laxity or loss of skin elasticity I usually have my patience, put the skin and pectoralis muscle on tension by putting the arm up over your head like your scratching the back of your neck.
This gives an accurate view access glandular tissue and its relationship to the subcutaneous fat layer.
 Consider taking pictures of yourself with fully extended at a time.
Without knowing what you look like before surgery, can’t really begin to make a good assessment.
It looks like there may be some residual glandular tissue, and maybe the subcutaneous fat layer was treated a bit aggressively.
 Your surgeon is the correct person to talk to regarding the procedure.
Provider will have their own way whether procedures are indicated or not.
To get a proper second opinion consultation, I suggest you schedule those as in person consultations with other plastic surgeons in your community.
 For second opinion, consultations prepared with you a complete set of before, and after pictures and preferably a copy of your previous operative report.
These are all part of your medical record that you can request from your current provider by simply requesting them.
Both the assessment and treatment of gynecomastia or fullness of the male chest is fairly complex and not always straightforward.
 All three of the tissue can have a major impact and differentiating between each of these is critical in order to understand someone’s candidacy for surgery or to understand the outcome of the procedure.
Best,
Mats Hagstrom MD

Chest asymmetry after gynecomastia surgery?

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Chest asymmetry after gynecomastia surgery?

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