Gynecomastia 7 weeks post op. All swelling went down on both sides but today 1 said is suddenly larger. Thoughts? (photos)

Question

7 weeks post op. After surgery my right side was always a lot more swollen than the left. A couple weeks later the right side started to even out with the left. All of a sudden this morning my right side is larger/ might be swollen. My surgeon said it’s not seroma or hematoma, he said it feels hard inside and could be scar tissue. He said to massage it super firmly to break it down. If it doesn’t subside in 2 weeks he wants to inject a steroid to break it down. What are you thoughts on this

Ned Snyder, IV, MD · Answer

Thank you for submitting your questions/concerns and photos.  At 7 weeks postop, it is still normal to have some mild fluid shifting which can make one side appear more swollen than the other.  This can be caused by many things, such as increased activity (especially if you are right-handed), sleeping on your right side, minor trauma to that side, etc.  I'd recommend wearing compression to see if that helps and follow up with your plastic surgeon. Thank you again for your inquiry and good luck in your recovery.

Anthony J. Wilson, MD · Answer

Thank you for your caution. I would be concerned at this point for fluid collection especially if it suddenly got larger. Have your surgeon re-evaluate the site and determine if there is fluid. If there is no fluid then likely residual edema from likely increased activities. Ensure that you wear your compression garment as much as possible as this will help with swelling reduction. Best of luck.

Stephen M. Davis, MD, FACS · Answer

Thanks for writing,As a general rule, 6 weeks is the point where scar tissue formation Is maximized. Typically after liposuction at about two weeks vessels are re-attaching and swelling  starts to decreases and tissues shrinkage starts to be come consistent. This is when continued use of a garment is your best friend. The garment compresses the tissues, control swelling and helps to control shrinkage of tissues. Seven weeks post-op would make me think of a late bleed, a seroma (fluid pocket) or a lymphatic injury. In either case physical examination and using ultrasound to see what is inside / under the skin would be helpful. Massage may help in association with compression. Without see you and no physically examination it is hard to be specific. I might be tempted to go back to the OR and open up the tissues and treat what needs to be treated and therefore get immediate resolution of the problem and hopefully get your breast back to where is was before the swelling and therefore offer you the best symmetrical improvement. Steroids can be helpful, but they cause fat atrophy, dermal thinning and  stimulate scar relaxation. In my mind control of the above is somewhat difficult with injection of steroids. A second opinion is not unreasonable if you’re concerned. I hope this helps, Good Luck Stephen M. Davis, MD, FACSCertified: American Board of Plastic SurgeryMember: American Society for Aesthetic Plastic SurgeryMember: American Society of Plastic Surgeons

Giovanna Ghafoori, MD · Answer

Good morning, 88Harold88.  I am sorry that you are having issues after your surgery.  7 weeks is a difficult time frame: On one hand, it would often be expected to have much more flattening of the breasts by this time that what your pictures are showing, but some patients can take much longer for the swelling to resolve and the skin to begin to remodel and tighten.  It is good that you are following up with your surgeon to monitor you and ensure that you didn't develop a seroma or hematoma.  I would recommend following your surgeon's massage recommendations closely -- massage is very important after surgery, particularly when there is excess inflammation.  I personally am leery of steroids, and very rarely use them to break up scar tissue as there is a moderately high risk of creating contour irregularities and skin/soft tissue thinning.  However, many surgeons routinely use steroids for this purpose.  I would defer to your surgeon's experience and recommendations.  I hope things settle down for you soon!  Best of luck, Dr. Ghafoori

Arian Mowlavi, MD, FACS (license on probation) · Answer

uneven breasts at seven weeks all of a sudden is due to either a seroma or hematoma; not enough time for scar tissue to build up; I would try to have it drained and then follow up with compression for one to two weeks. Follow up with your surgeon.

Frederic H. Corbin, MD (license restricted) · Answer

Sorry for your problem but an examination is really needed so follow your surgeon’s recommendations or seek a second opinion from an expert in the area after a full examination Dr Corbin

Gynecomastia 7 weeks post op. All swelling went down on both sides but today 1 said is suddenly larger. Thoughts? (photos)

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