Can Gynecomastia Scars Be Improved?
Q: Dr. Eppley, my son had gynecomastia surgery last year and has developed severe scarring from this surgery. We have tried creams, silicone sheets, several rounds of shots and laser treatments as well. Nothing has helped for his scarring. It is so sad that a 17 year old young man is unable to remove his shirt in front of anyone, due to the embarrassment from these scars. He often has sharp pains from the scarring that requires him to rub out the pain. As you can tell from the attached pictures, the scarring on his right side is much worse than the left. This is due to the fact that he formed a hematoma under his right nipple after surgery and required a second surgery on the right side to remove the hematoma. I would appreciate your opinion to see if a scar revision and possibly radiation to prevent new keloids from forming is a possibility.
A: Thank you for sending your son’s pictures. I can clearly see that he had an initial periareolar approach to his gynecomastia reduction surgery. Due to the maturity of his scars, it appears that surgery was done at least a year ago. While I have no idea as to the magnitude of his original gynecomastia problem, I see the following current problems; wide hypertrophic periareolar scarring, a residual mega-areola deformity and some persistent gynecomastia fullness. His periareolar scarring does not represent keloids but rather is hypertrophic scarring, a not uncommon reaction to periareolar mastopexies in general. This is normal scarring that develops from tension and/or suture reactions from this type of procedure. It is not pathologic scarring nor would ever merit being treated by radiation after revision. While I can appreciate all of the scar treatment strategies done after his surgery to try and improve his scarring, re-excision was only ever going to be a strategy that has a chance to work. No scar treatment other than excision will ever make wide scarring more narrow. The main benefit to all these other scar treatments was that they have allowed time to pass for the scar tissue to settle down as well as being proactive along the way.
He clearly would benefit from periareolar scar revision combined with further areolar reduction and maybe some additional gynecomastia tissue reduction. The burning question is will this scarring problem recur and what can be done to prevent it. While I have my own techniques for how I do this surgery, it is always helpful to know what was done in the past. As the old motto goes ‘past history predicts future behavior’. From that perspective, I would need to see his previous operative note to understand what closure techniques were done so what didn’t work well would not be repeated.
Dr. Barry Eppley