Q: Dr. Eppley, I had gynecomastia reduction surgery 2 months ago and I am not happy with the results. It was initially very flat right after surgery but I have subsequently developed hard lumps under the nipples that now make them stick out a bit. This makes me mad since I paid good money to have a flat chest. What can I do about it now?
A: What you are describing is very common after gynecomastia reduction surgery in young men. Many open gynecomastia patients will develop a scar lump under the nipple after their procedure even though it looked initially quite fat. Whether this scar lump will go away or not takes time to see and two months after surgery is too early to tell. About 10% of open gynecomastia reduction in young men will develop these persistent scar lumps that may require a revision to remove and make completely flat if it persists. This is not reflective of a poor surgical technique or even a poor surgical result but is the unknown and uncontrolled variable of how one forms scar tissue in the space where a small or large lump of tissue had been removed. What I would recommend now is to have either Kenalog (steroid), 5-FU or combination kenalog/5-FU injections to try and soften the scar and make it go flat. Now is the time to do this, not 6 months after surgery where it would be much less effective when the scar tissue is mature. Whether this will be completely effective can not be predicted but at least this provides a chance for success. If not, you are going to require a revisional gynecomastia reduction procedure to remove the scar that has developed.
Dr. Barry Eppley