Would My Recurrent Nipple Protrusion After Gynecomastia Reduction Be Helped By Steroid Injections?

Q: Dr. Eppley, I had gynecomastia reduction surgery performed back in March of this year.  The results immediately afterwards were amazing, everything was completely flat.  A month or so after I started developing scar tissue which hasn’t gone away and has made my nipple area protrude once again. My plastic surgeon said I probably needed a steroid injection to help with the scar tissue.  Since it is much further to travel back to him I went to a local plastic surgeon, but he thought it was just some leftover breast tissue and didn’t want to do the Kenalog injection. No offense to him, but I don’t feel like he had much experience with gynecomastia and I definitely feel like it is scar tissue since the results after surgery were a completely flat chest with no feeling of any tissue whatsoever. That led me to come across your website where some people had asked about Kenalog injections for scar tissue after gynecomastia surgery. Based off what I have told you, does it sound like scar tissue to you or is it possible that the gynecomastia has actually grown back?  I would be interested in seeing you for Kenalog injections if you believe they would be beneficial. I have attached a picture of the before and immediately after surgery.  I would really appreciate any information you could give me so I can get this behind me for good.

A: I have done a lot of open areolar gynecomastia reduction surgeries in young men just like yours. What you are experiencing is not uncommon. It looks really flat in the beginning but a slow nipple protrusion develops. The tissue under the nipple-arolar complex feel firm, sometimes harder than before the initial surgery. You are correct is that it is scar tissue and not breast tissue. But often considerable scar tissue develops and the mass effect is almost like it was before surgery in some cases. I have done my fair share of steroid injections into this scar tissue and that seems to be the logical approach to do. But I have yet to see a case in which the steroid injections were successful, particularly at over six months after the initial procedure. My experience is that the only thing that solves the problem is to surgically remove the scar tissue, very much like the original surgery. While there is no harm in doing steroid injections, and the protocol would be a series of three injections spaced three weeks apart, I have little optimism that it will lead to a complete resolution of the problem.

Dr. Barry Eppley

Indianapolis, Indiana