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Category: Gynecomastia recovery

Massage After Gynecomastia Surgery

Massage for Gynecomastia patients in San Francisco

Scarring can be very unpredictable, and no two patients will heal the same. As the body recovers after gynecomastia surgery, there will be scar tissue forming both internally and externally. Sometimes the scar tissue may feel lumpy, and some men are fearful their man boobs are returning. This scar tissue is not breast tissue and will not affect the overall appearance.

Scar Tissue After Gynecomastia Surgery

Scar tissue will not disappear if it is massaged, but there are benefits to be gained, Dr. Miguel Delgado, M.D.  has his patients start a gentle massage after about 3 weeks as long as it is not painful. To start massaging before then may cause unwanted swelling.

 

The Benefits of Massage

The skin may feel hypersensitive as healing takes place and sensation starts to return. Massage may reduce the sensitivity. In addition, massaging can help the body get rid of pockets of fluid and reduce swelling. Massage may help internal scarring to be looser and more flexible. Massaging external scars with a lubricant may prevent scars from cracking and drying out.

How to Massage

If you are instructed to start massaging, the way to do it is; raise one arm over your head, take the three middle fingers of the opposite hand and gently use a circular motion on areas that feel firm. Gradually increase the intensity, but not to the point that it hurts. Massage for about 5 minutes on each side two times a day.

Options for Scar Revision

It isn’t possible to avoid scar formation after surgical procedures. However, there are treatment options available to reduce scar tissue such as; steroid injections, or even a minor scar revision surgery.

Do not attempt massaging your chest unless directed by your surgeon.

Call Now!

For additional information for any gynecomastia concerns, call today (415) 898-4161 for an appointment with Dr. Miguel Delgado, M.D.

 

Scar Tissue After Gynecomastia Surgery

Scar tissue After Gynecomastia surgery in San Francisco

Before and After Gynecomastia Surgery

Two really excellent sources in getting feedback from gynecomastia patients are the websites; Gynecomastia.org and RealSelf.com. One concern, which comes up from time to time on both sites, is men who state that after a few weeks their gynecomastia has come back.

Scar Tissue Feels Like Breast Tissue

Recurrence of breast tissue is an alarming situation for men who have invested in their male breast reduction, only to have it come back. As long as the patient has not resumed in taking medications, steroids, or other known causes of gynecomastia, it most likely is not regrowth of breast tissue. If the original outcome of surgery was a nice sculpted chest, the recurrence of puffy nipples or the feel of breast tissue under the skin is most likely the formation of scar tissue. Scar tissue can form any time after surgery, usually within 4 to 12 weeks.

Puffiness May Be Swelling

If there is puffiness right after surgery it could be swelling or possibly not enough breast tissue was removed, but it would not be caused by scar tissue.

Men are encouraged not to panic but to talk to their surgeon about their concerns. The formation of scar tissue most likely will not require surgical intervention. Most of the time, the scar tissue will resolve on its own. However, after recovery, the surgeon can give injections of steroids such as Kenalog. Over time the steroid may dissolve the scar tissue.

Choose Your Surgeon Carefully

It is imperative to choose your gynecomastia surgeon carefully. Many surgeons are concerned about removing too much tissue and creating a “crater deformity,” or they are over cautious and do not remove enough. In either case, gynecomastia revision surgery will be necessary. With the addition of scar tissue from the original surgery, you will need the expertise of a gynecomastia specialist.

Call Now!

Dr. Miguel Delgado, M.D. states that more than 40% of his gynecomastia practice is revision surgery.  Under resection or over resection is the primary cause for revision surgery. If you are having any issues with gynecomastia, call today (415) 898-4161 for a consultation with Dr. Delgado.

 

Dr. Delgado Talks About Drains and Compression Vests

 

Dr. Delgado, a specialist in gynecomastia has been performing male breast reduction since 1989. Considered one of the top gynecomastia surgeons in all of the United States he has patients who travel from all parts of the United States and other countries to be treated by him.

Dr. Delgado is a Leader in Gynecomastia

Dr. Delgado provides the latest in technology and technique to his patients, many of which he designs himself. The result is a high satisfaction rate he receives from his patients. In the before and after pictures below is a delighted patient who wanted to share his own photos.

Dr. Delgado has a happy patient

In listening to his patients, Dr. Miguel Delgado,M.D. learned that the tiny scar left by the incision made for the drain was quite bothersome to many patients. Dr. Delgado explains in detail the need for drains; you can read more about that in the blog dated September 2017. Note in the after picture below where you can see the small scar right below the armpit.

Scar from drain before new technique

By moving the incision high up into the armpit, once it has healed patients have a hard time locating it!

Patient Comfort is Key

Another innovation by Dr. Delgado is the design of his unique compression vests. Previously commercial vests were bulky and did not have a provision for the awkward drain bulbs. Before, the bulbs were attached to the vest with a safety pin as shown in the picture.

Dr. Delgado vest

Dr. Delgado designed his vest with removable pockets that hold the bulbs. Once the drains were removed, the pockets came off making the vest less bulky. Also, the shoulder straps are adjustable allowing for more comfort. Then there is a second stage vest that is used when healing has progressed. The second vest is made of thinner material and has compression over the chest only. Lined with a soft T-shirt fabric, the vest is even more comfortable and undetectable under most shirts.

Call Today!

Are you ready to address your gynecomastia concerns? Call now(415) 898-4161 for an appointment with Dr. Delgado; you will be glad you did!

What Causes a Seroma and How to Avoid it

seroma and gynecomastia in San Francisco

26 year old male who presents with adolescent gynecomastia. He is 6 feet tall and weighs 245 pounds. He had 50 grams of breast tissue removed from his right chest and 77 grams  from his left . He had 250 cc. of fat and aspirate removed from each side of his chest. His post op course was uncomplicated.

A seroma is a collection of clear serous fluid most often at a surgical site where tissue has been removed. This can be a complication after gynecomastia surgery. The swelling and fluid may not happen right away but can develop several weeks after surgery.

Seromas Lead to Serious Complications

Usually, a seroma will resolve in a few weeks, but the accumulation of fluid will cause the skin to sag and may cause discomfort. In some cases, a seroma can lead to serious complications, such as infection, and delayed wound healing. If an infection should occur, it may have developed into an abscess requiring medical treatment. The patient will be instructed to notify the surgeon of any noticeable swelling or abnormalities.

Small seromas may resolve on their own, but if left untreated they may calcify and form solid knots. Larger seromas may require needle aspiration or even drain replacement.

Methods of Prevention

Drainage is the most accepted method of prevention along with a compression garment. A compression vest will help the skin and tissue heal faster, reduce swelling and bruising and reduce the risk of developing a seroma.

A hematoma is different than a seroma in that a hematoma contains red blood cells, and an abscess is different as it contains puss from an infection.

Drains and Compression Vests

Some surgeons do not use drains, and some do not use compression vests after gynecomastia surgery. Dr. Miguel Delgado, M.D. not only advocates the use of drains, he also is a firm believer in compression vests. Dr. Delgado designed his own compression vests that he makes available to his patients. His custom-made vests have pockets for the drain bulbs to rest in, instead of being attached with safety pins. These custom-made vests additionally aid in binding the chest tissues together, decrease post-operative pain, and increase blood flow.

Dr. Delgado has over 25 years of gynecomastia surgery experience, and he states that his incidence of complications is very minimal. Call today (415) 898-4161 for a consultation for any gynecomastia issues you may have.

 

Gynecomastia and the Need for Drains

 Drain for gynecomastia in San Francisco

Some men have voiced concern about the use of drains after male breast reduction surgery. They are somewhat cumbersome, and a little uncomfortable when removed, but the advantages greatly out weight the disadvantages.

Drains May Prevent Infections

Drains collapse the “dead space” that is left after surgery. Without the drain, the space may collect fluid and can cause an infection or other complications. The type of drain used is called a Jackson Pratt which uses mild suction removing fluids through a clear plastic tube from the surgery site to a small bulb that is placed in a small pocket of the compression vest.

Periodically the bulb needs to be emptied and Dr. Miguel Delgado, M.D. wants the patient to keep a log of the amount of fluid removed and its color. This information is important for Dr. Delgado to monitor how the healing is progressing.

The most common drainage is serosanguinous, which is a thin watery substance usually pink to dark red from red blood cells. If the fluid is thick and the color is yellow, green, tan, or brown, it is referred to as purulent exudate and may be an indication of bacteria present in high levels or an infection.

Experience Proves the Advantage of Drains

Some surgeons use drains, and some do not. Dr. Delgado has over 25 years of gynecomastia surgery experience, and he claims that by using drains the incidence of complications is very minimal. If drains are not used it is possible that fluid may collect in the “dead space” and will need to be aspirated and maybe more than once.

For most patients, the drains are removed at the first post-operative visit usually within 4 days. When the tube is removed from the surgery site, you may feel a slight burning sensation, but it only lasts a few seconds.

Stay in Touch With Your Surgeon

Dr. Delgado instructs his patients to notify him if any of the following conditions are noted:
• Fever
• The color of fluid is brown, yellow, or green
• A change in the odor of the fluid
• An increase of pain

For any concerns about male breast reduction, call now (415) 898-4161 for an appointment with Dr. Delgado.

What to Expect After Gynecomastia Surgery

Gynecomastia surgery in San Francisco

Gynecomastia Surgery Results

Anticipating gynecomastia surgery may cause anxiety for many men. Not knowing what to surgery results to expect can cause further stress. The expert gynecomastia surgeon’s goal is to achieve a natural looking male chest with masculine contours. If the surgeon removes too much breast tissue, the result could be what is known as a “crater deformity,” and if not enough tissues is removed, more surgery may be needed. It is important to select an expert gynecomastia surgeon so you can get it right the first time!

Compression Vest and Drains

After surgery, you will be placed in a compression vest and have drains in place that remove excess fluid and keep swelling under control. The drains are generally removed within 2 to 3 days at the first post-operative visit. Sutures are taken out after 1 week. The vest is to be worn 24/7 for 5 or 6 weeks and only removed when showering. Showering is allowed a couple of days after the drains are removed, and the drain incisions have completely closed. When removing the vest, men need to realize that they are not seeing the final result. There will be swelling and bruising, and the incision at the bottom of the areola will be evident. However, bruising will completely subside in about a week to 10 days; swelling may last several weeks.

Incisions Well Hidden

As the incision around the areola heals, it will be almost undetectable due to the change of skin texture. The small incision from the drain at the side of the chest may leave a scar. Sensitive to men’s comments about this, Dr. Miguel Delgado, M.D. now places the drain incision high up in the armpit and toward the back, most men cannot find it after it heals.

It is not unusual for the swelling to take several weeks to completely resolve. Some swelling is normal as it increases blood supply to the injured area bringing nutrients that aid in healing. However, any unusual swelling needs to be monitored for a possible hematoma (abnormal bleeding outside blood vessels.)

Going Shirtless Becomes a Reality

As the swelling subsides, the final contour of the chest will become evident, and the ability to go shirtless will become a reality!

Unfortunately, for some men, once all the swelling has diminished they may have what is referred to as “puffy nipples.” The cause for puffy nipples is when the surgeon has not removed enough breast tissue that is behind the areola, and the tissue pushes the nipple outward. This condition can be fixed but requires additional surgery. Choose your surgeon carefully!

Call Today!

Gynecomastia patients are encouraged to call now (415) 898-4161 for a confidential consultation with Dr. Delgado.

 

Gynecomastia Surgery Recovery, What to Expect

Gynecomastia surgery in San Francisco

Be Patient, Swelling Takes Weeks to Resolve

Recovery from gynecomastia surgery, like most surgeries, will go through several stages. You will experience bruising and swelling. The bruising may be minimal, or for some, it can be quite extensive, healing can take 2 to 3 weeks.

Swelling is normal with most of it subsiding in a few weeks but may take several months for all of it to resolve. However, severe swelling can be the sign of something more serious such as a hematoma. A hematoma is bleeding under the skin. A very low percentage of Dr. Delgado’s patients experience this complication due to his advanced surgical techniques.

Drains and Sutures

Drains will be placed at the end of your surgical procedure to remove fluid that accumulates naturally. The drains will be removed at the first post-operative visit, usually within 2 to 3 days. Additionally, sutures are removed after 1 week.

After surgery, Dr. Delgado has his patients placed in a compression vest to be worn for 6 weeks and emphasizes there is to be no strenuous exertion or formal exercise for 4 to 6 weeks.

Protect Gynecomastia Scars From the Sun

Patients are warned to keep their chest out of the sun for several months. The sun can cause hyper-pigmentation on fresh scars turning them permanently dark. Once a scar is no longer pink sun exposure should be safe, but the use of sun block is recommended.

Gynecomastia patients may have a temporary decrease in the sensation of the nipple-areola complex, for most patients it is insignificant, but for some, it may take a year for full sensation to return. Massage is recommended to reduce hypersensitivity of the skin as sensation returns.

Blood Thinners Must be Avoided!

Dr. Miguel Delgado, M.D. warns patients to continue to avoid all blood thinners for at least 2 weeks after their surgery because it is possible to still have a bleeding issue. In addition, he advises his patients to follow a healthy diet for a faster recovery.

Schedule a gynecomastia consultation today (415) 898-4161 with Dr. Delgado to address any male breast issues you have.

Gynecomastia Scars after Male Breast Reduction Surgery.

 

A disappointing result after gynecomastia surgery is poor quality gynecomastia scars after male breast reduction surgery. Many treatments can improve the quality of the incisions. 

As with all surgeries, incisions that result in scars can not be avoided. Many factors go into the formation of a scar.

  • Genetic predisposition – some people are programmed to form keloid or hypertrophic scars.
  • Tension – a high amount of tension on the scar will create forces to pull at the incision and creates more scar tissue.
  • Location of the scar – If the scar is on very mobile areas like the shoulder, chest, or knee the scar then to be much worse
  • What is the scar due to – Is the scar injury formed by a control instrument like is scalpel or from a burn, crush injury, etc.
  • Ethnicity – Pigment in the skin will create more color variation in the scar and sometimes surrounding the scar. The pigment melanin can play a significant role.
  • Sun Exposure – early sun exposure can affect the skin pigment of the scar in the initial healing phase.

Gynecomastia Scar Characteristics

The gynecomastia scar is created in a unique hidden area. It is the lower half of the areola, where the areola and normal skin pigment meet. The incision is called a Webster incision. This surgical approach is the exact incision for breast augmentation!

Webster surgical incision underneath  the areola

webster incision- gynecomastia incision

The gynecomastia scar is not under skin tension as it heals, and this encourages proper quality healing. The pigment will vary from patient to patient, and another essential factor is the grade of gynecomastia or the size of the condition. The Webster incision can be very short and is determined by the size of the areola. If the gynecomastia’s grade is 2-or 3, the incision can be more traumatized by operating through a small incision with a lighted retractor. The stretching of the skin can affect the quality of the scar.

 

When will the scar be completely Healed?

The initial healing will take place in a few weeks. This is when the sutures are removed and the scar tissue has bonded the edges together. The final outcome is not seen for nearly a year. This is when the scar tissue has completely softened and the pigmentation is set for life.

How to Treat Poor Gynecomastia Scars?

It is unknown why some people are more susceptible to scar formation than others. Scars are a natural result of the body healing itself when there has been trauma to the skin. During the initial healing process, the body produces collagen fibers that will end up having a different texture than the surrounding skin. Sometimes the body will overproduce collagen, creating a buildup of tissue, resulting in a firm raised scar known as keloid or hypertrophic scars.

 

Skin incision Before and After Scar Treatment

Before and After Scar Treatment

In many cases, it is not medically necessary to remove these benign scars. However, if they are noticeable, they may cause a lot of discomfort to the gynecomastia patient who wants to go shirtless after surgery.

There are several options available for scar removal, including; steroid injections, silicone sheet or gel therapy, and laser treatment, such as the non-invasive Palomar Icon Fractional Laser. The last option is very simple scar revision and under local anesthesia.

Having a Board Certified Plastic Surgeon who specializes in gynecomastia is your best bet for avoiding noticeable scars. Patient participation in preventing unsightly scars is crucial. Be sure to follow your doctor’s post-operative instructions that should include; avoiding direct sunlight for six months to a year. Sunlight is known for contributing to hypertrophic scars. Using silicon sheeting once the incisions have healed have proved to be very beneficial in scar prevention.

 

Man Standing with before and after photos of gynecomastia surgery

Before and After Gynecomastia Surgery

If you are struggling with unsightly scars after gynecomastia surgery, schedule a free consultation today (415) 898-4161 with Dr. Miguel Delgado, M.D. to find what options are available to you for removal.

How Visible are the Gynecomastia Scars after Surgery?

drain-scar - photos before and after

The gynecomastia scars from the drain before the new technique.

For the San Francisco Bay Area man, in order to remove male breast tissue and fat during male breast reduction surgery, an incision is made at the bottom half of the areola, between the darker and lighter skin. When it heals the gynecomastia scar is almost invisible. Chest hair can also help in hiding the incision. The healing process can take up to 6 months to a year.

I recommend silicone sheeting about 10 days after the gynecomastia scars are healed. Silicone sheeting helps soften and lighten the color of the gynecomastia scar. I also do a tiny incision in the armpit for the liposuction cannula and for the drain.

My San Francisco patients let me know that the tiny scar left by the drain under the arm was a point of concern, now by a new technique I place it high up in the armpit toward the back, most of my patients have a hard time finding it.

Depending on the severity of the gynecomastia grade this will determine the type of incision, sometimes it can be less, in some cases, it can be more if a second stage reduction is needed.

Stage Two Gynecomastia Surgery Update

On April 2, 2011 a blog was presented on second stage gynecomastia surgery. This is where the male breast reduction patient with moderate to severe gynecomastia is in need of a second procedure due to the large amount of redundant skin needing to be excised. These photos show an excellent example of a recent patient with severe gynecomastia.

 

 

 

Severe gynecomastia photo patient

Severe gynecomastia

Photo After gland excision

Patient after gland excision, liposuction, superior crescent lift and external lift sutures

After Severe gynecomastia pic patient

He is seen six months later

Male after Gynecomastia Surgery - photo 6 months later

He is seen two weeks after Stage Two Surgery

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