1 Week Post Op and interesting facts about Peri/Keyhole/Gynecomastia

Posted: July 26, 2010 in Changes, compression, Gynecomastia, Keyhole, Mastectomy, Peri Areola, Post-op, Top Surgery, Transgender, update

Well i made it to week one and things really look a lot better then it did on day 3 already. A lot has been going on with sensation and things off that nature. I have a lot of tingling going on which is a greattttt thing that means sensation is slowly returning as my nerves come out of shock. I am very very very happy with my chest even with this annoying fold but I found out that is is often occurring when the glandular tissue is removed. Another cool fact I found in my nerdiness was that when the glandular tissue is removed that the areola often shrinks its self. I have noticed that happening little by little. I’m just very happy I kept my results realistic in my heart and mind and even though its only day 7 I know that what  I see now will not be what I see at day 70. Peri is all about time, patience, and the bodies ability to heal itself. I didn’t have excess skin prior to surgery so its just a wait and heal kind of thing.

I have also been applying circular massage to my chest to loosen up the scar tissue. Another thing that I noticed behind the crease I have is built up scar tissue there as well and until my areaola is fully sealed at the incision site I cant actually loosen that tissue up. Just with the massage I have started already I notice the bigggg difference in the areas that were lipoed they are actually starting to fill in a bit and immediately after massages the areas are softer and feel a lot more like they did pre surgery which is an excellent thing indeed. once my incisions are fully healed I know with massage on the regime I am on things will be perfectly fine. I can say I do not have any real sensation as far as erotic BUT I do have pressure and temperature sensation on both sides which is awesome. I have that kind of feeling in my chest when you foot falls asleep. That’s what happens when I touch the areas that were lipoed its actually kinda funny to run my fingers across those areas. No nipple feeling at all but they do respond to touch which is an excellent sign, I’m not too worried about feeling coming back I don’t use them for anything so they are kinda like decorations lol. But this is the beauties of any surgical procedure time and patience is the key.

I also had to get rid of the standard ace wrap the Dr. sent me home in it was actually curving to the folds instead of keeping me completely compressed. Not to mention the shit kept slipping off while i was sleeping and I hat waking up and having to readjust myself lol. I went to Walgreens (<<click the word Walgreens for the binder) and brought a simple post surgical abdominal & back support binder with Velcro adjustments. Just within 24 hours I can already notice the difference with added compression and no conforming to my lipoed sections of my chest (look at the post op healing section to see how it fits me).

My massage regime is pretty simple but I’ll list it here for those that maybe on the same route as myself:

1. Wake and shower to make sure all skin is clean of bacteria (I use dove body wash for men) DO NOT scrub your incisions wash with your hands or soft washcloth. washcloths made for infants are ideal.

2. Pat your chest dry DO NOT rub, you don’t want to risk the chance of re-opening yourself.

3. Make sure your hands AND nails are clean of all bacteria and dirt before touching your chest, you want to take no chances with any infections. Begin in a spot that is comfortable for you and 2 fingers massage in small circles until you have massaged that complete side of your chest, DO NOT massage the areola/nipple area until your incisions are fully healed. It WILL feel tender but it SHOULD NOT hurt. IF it hurts STOP and consult your Dr. ASAP it maybe the signs of something else brewing like a seroma or hematoma.

4. Repeat step 3 on the opposite side until you are satisfied.

5. Check both sides and you should see and feel the difference the difference in the internal scar tissue. Instead of being hard and lumpy it should be now soften and a bit less tender.

6. Apply gauzing and reapply bandaids on the drain sites for sterile purposes (only while the incisions are still healing). Re-wrap yourself firming but make sure while wrapping to exhale fully also that you have made sure you have room to breathe.

7. ALL DONE 8D!

I have found that massaging 3 times a day works for me and I can noticeably see the difference in the skin and its elasticity as well as the internal scar tissues softer and a lot less tender after each session of massage. The added compression is definitely working many wonders. Many people choose not to stay compressed after surgery for many reasons but me personally I think a good 6-8 weeks of compression will do me very good if not longer. The post surgical compression I have is very concealed, not hard to breathe in, doesn’t slip down, very breathable even during my night sweats it actually keeps me very dry. So I have no issues being compressed for best results, like I say better safe then sorry.

Also in my late night researching I cam across some very helpful info on:

GYNECOMASTIA.ORG

A well known FTM surgeon frequents these forums and as you see below he specializes in gynecomastia, he was my out of pocket Dr. choice if insurance did not pay for my surgery.

Michael Bermant, MD
Board Certified
American Board of Plastic Surgery
Specializing in:
Gynecomastia Male Breast Reduction

CLICK HERE TO SEE A LIVE GYNECOMASTIA SURGERY PREFORMED BY DR. MORDCAI BLAU

Here’s some info I found that was useful for me as well:

Recovering From Gynecomastia Surgery

After Gynecomastia:
What To Expect In the Days, Weeks, and Months After Male Breast Reduction Surgery
By Dr Mordcai Blau

Swelling & Bruising After Gynecomastia

Swelling and bruising are normal phenomena after  surgery. Bruising (ecchymosis) can appear in various degrees, ranging from minimal to massive. It can be confined to the breast area or expand to the chest and abdomen. Bruising can appear as bright red, black, blue, purple, or a combination of colors. It will increase in intensity over the first 3-4 days, and then will diminish and become yellowish for another week or so. The discoloration will usually disappear in 2-3 weeks. During this time sun exposure is absolutely forbidden due to the possibility of permanent skin discoloration.

Swelling can be diffused or localized. Diffuse swelling can be treated by cold compress for the first 2 days and warm compress thereafter. Localized or minimal swelling is asymptomatic and no treatment is required.

Severe swelling can sometimes occur after surgery. The following are the forms of severe swelling:

Hematoma: – is an acute collection or accumulation of fresh blood that can happen within the first 10 days post surgery, most commonly in the first 3 days, and causes an extreme, painful swelling of the breast. The breast feels hard and tender to the touch. There usually is blood on the gauze. Most often it is unilateral although it can be bilateral.

Severe cases require urgent treatment, and next day treatment is suitable in less severe cases.

Treatment can be of two varieties. In open treatment, the operating wound has to be opened and the blood clot evacuated through hemostasis (stopping the bleeding). Another treatment is done by puncture. Using a large gage needle under local anesthesia, the blood clot and partial operating wounds are evacuated by separation and drainage of the blood. Sometimes this treatment is only available when the blood clot liquefies within 2-10 days.

Seroma: – is a combination of body fluid and liquid blood products. It is very liquidy with low viscosity and appears as red-orange color. It can easily be evacuated by a large gage syringe puncture under local anesthesia. The seroma usually needs a few evacuations 2-3 times over the first week or two after Gynecomastia surgery.

Pressure dressing is required for 3-5 days after evacuation of the hematoma or seroma.

When the correct treatment is done, late side effects such as excess skin, infection and discoloration are rare. Preventative measures to avoid bleeding and prevent hematoma formations include:

  • Cessation of medications like aspirin and other all-natural supplements (you should get the list from your surgeon) 2 weeks prior to surgery.
  • Restricted movements and exercise (see post op rest & exercise section).
  • Compression during the first 5 post op days.
  • Post surgery drains for certain patients that have excessive bleeding during surgery.
  • Patients that takes Hypertension (High Blood Pressure) medication should not stop it and take it the day of and the days after surgery.
  • Stop alcohol and steroids prior to surgery.

Rest & Exercise After Male Breast Reduction Surgery

The first 3 post op days are the most critical time for the Gynecomastia patient. He must be in full rest at home (not necessarily on bed rest; sitting and watching TV or having meals in the kitchen are permissible). Going out to the mall for a few hours is forbidden. Movements of the waist and elbow are ok but the vigorous movements of the shoulder joints have to be restricted (curtailed) for the first few days. Lateral arm movements are generally permitted, but it is forbidden to lift the arms vertically. There are many variables and you should consult a board-certified plastic surgeon for more details.

The following are only general instructions (every patient has different needs): Prolonged walking and jogging can be done after 2 weeks. More extensive exercise including leg and arm exercises (not including shoulder joint and arm movements that use the pectoralis muscle) can be started in 2½ – 3 weeks and intensify over the next 2 weeks. Chest (mainly weight lifting) and intensive abdominal &amp; back exercises are generally permissible after 4-5 weeks. Sex is not recommended for the first 7-10 days.

Compression Dressing for the Gynecomastia Patient

Every surgeon has his own experience, and the type of dressing is up to the surgeon. Most surgeons use some kind of dressing or compression garments like vests, ace bandage, elastic bandage and other types of dressings.

The length of time the dressings are used varies from a few days to a few months. Personally, for my patients I determine the length of time the compression dressing should be used according to the severity of the surgery and the amount of bleeding and swelling. I always leave it for at least 5 days. It is at this time that I usually remove the sutures. Should the patient’s chest be very swollen, and if seroma or hematoma is present, I will apply new compression dressing for an additional 5 days. After this next 5-day period, I examine the patient again and usually remove the compression dressing. Only in very few circumstances will I leave it for additional time. According to my experience any compression dressing is most effective in the first week after surgery.

Sun Exposure after Gynecomastia Surgery

As after any surgery, exposure to direct sun or tanning should be avoided for about 6 weeks, until ecchymosis (bruising) and a fair amount of swelling subsides.

The main reason is that the sun rays will prolong the swelling and may cause the discoloration to be permanent. Sun exposure in the early stages can cause the scar to become more noticeable later due to pigmentation.

Therefore, when going out on a hot summer day with light clothing or no shirt, a sun block of at least 30 SPF should be applied for the first few months.

Post Surgery Scars

In my 25 years of experience with male breast reduction surgery I have found that typically the best location for the scar is periareolar (the lower lateral part under the areola) with a length of about one inch.

Most other scar locations will cause it to appear more conspicuous. After performing thousands of male breast reductions I have observed scars on the upper areola, sides of the areola, inside the areola, and many others. Scars done in the axilla (armpit) are not effective for me because I cannot excise the entire gland from this site.

“Domate incisions” around the entire areola are rarely necessary and should be avoided as a rule due to the possible thick, irregular, and prominent scarring it often causes.

Mederma, scar guard and other scar reduction creams should be used only as directed by your experienced board-certified plastic surgeon. In my experience they are helpful only in certain conditions (tendency for hypertrophic keloid scars) and are used as a preventive measure and post operatively. In my opinion it is unnecessary to use these products with the majority of Gynecomastia patients.

Many male breast reduction patients develop post op inner scars in the surgical sites. It can be felt as a hard “Donut” surrounding the nipple or lumps behind the nipple areola complex extending medially and laterally (toward the armpit)

This hard inner scar phenomenon is normal and appears very frequently. At times it can be mistaken as an incomplete excision of the glandular tissue. Fortunately, in my experience inner scars will disappear within a few months after the surgery. Rarely, there may be a need for scar excision. This is due to the rare tendency to produce an abundant amount of scar tissue while healing.

Major Breast Reduction

Should there be a need for a major breast reduction in those patients that have extremely large breast (C or D-cup compared to women’s breast sizes) I may perform a superior pedical breast reduction (Weiner technique), or sometimes an inferior, oblique, or medial pedical. The problem in such an extensive breast reduction is the scarring that extends from around the areola to an inverted T (a vertical incision and then horizontal incision that is placed in the Infra mammary crease). I found, using my own technique modifications, that the shorter the vertical component, the better the overall final appearance. In some cases an injection of Kenelog, a kind of cortisone, may be used to improve hypertrophic scars (keloid). This is not often necessary.

Nipple-Areola Sensation and Gynecomastia Surgery

As with most surgeries there may be an area around the operating wound that will suffer a temporary decrease in sensation. From my experience it happens more often in patients with enlarged male breast that also require significant liposuction. Most male patients find the temporary loss of sensation to be insignificant. Sensation returns after a year for most patients.

Natural Shrinking of the Areola After Male Breast Reduction

There is a phenomenon of spontaneous shrinking of the entire areola after the male breast reduction surgery. The diameter of the areola will decrease 10-50% from the original size. This occurs in most patients when significant amounts of glandular tissue are removed. Therefore when a significant amount of breast tissue is removed over 90% of patients will experience this natural phenomenon of a spontaneous decrease in the areolas diameter. This is another reason why I rarely employ excision around the areola.

Massage Post Gynecomastia Surgery

The purpose of massaging the breast post operatively is to break up and reduce the bulk of the scar tissue.

Massage can done with the palm of the hand or between the thumb and the other fingers. Gentle massage is superior to rough massage and it should not be painful, just tender. It should not be started in the first week. I want to stress that massage after gynecomastia is not necessary in many cases. It can be helpful with the temporary conditions of scarring and swelling but does not improve remaining glandular or adipose tissue. In other words it is not a solution to get rid of tissue that was not excised during the male breast reduction procedure. For scar tissue, the injection of kenelog is much more effective.

Pain Post Male Breast Reduction

Pain tolerance is very individual. For many patients the pain is moderate at best and for the majority their expectations were worse than their actual experiences. When extensive liposuction is done the patient may complain of soreness equivalent to a day of exercise. Patients are sometimes provided with a prescription for hydrocodone but most do not need more than extra strength Tylenol.

Alcohol, Diet, Medications and Gynecomastia Surgery

Gynecomastia patients that have severe medical problems will need clearance from their physicians.

The list of medications to be avoided is sent to the patient with our pre-surgical booklet and includes blood thinners like aspirin and other medications. All nutritional supplements should be avoided for the same reason. Alcohol consumption should be decreased starting one week prior to surgery and one-week post surgery and should be totally avoided a few days before and after surgery. All steroids should be stopped two weeks prior and two weeks post surgery. Our patients are provided with a detailed guide listing everything that must be avoided.

Traveling for Gynecomastia Surgery

We assist our patients that are traveling from other countries, states and cities with their lodging arrangements by providing hotel options near our facility.

Since our location is in the heart of White Plains there are several convenient lodging places two blocks from the office.

Dr. Blau may begin the correspondence over the internet and give online complimentary consultations, but the patient has to be examined a day prior to surgery for the final determination.

The patient has to provide us with photos and a detailed medical history and will get a comprehensive booklet that is addressed to his specific needs. After the surgery patients will remain in the office facility until they are completely stable and then one of our staff members will take him to his lodging place.

Depression of the Nipple–Areola Complex, Creasing, and Loose Skin

Depression of the areola is extremely uncommon in our patients but may occur post surgery and will usually subside within 3-6 months. Should the problem persist after 6-12 months there may be a need for adipose transfer from the abdominal area that is a pretty simple procedure generally performed under local anesthesia.

So far, after thousands of Gynecomastia cases, we have never had the need to perform this procedure. I attribute this to my “Natural Blend Technique” that emphasizes proportionality and the needs of each individual patient.

In some patients with diminished elasticity (more common in elderly patients) there may be excess skin or skin creases that are more noticeable post op. Most of those creases will persist for 6-12 months and then diminish significantly, and the loose skin usually tightens.

Follow-Up Visits After Male Breast Reduction Surgery

The 1st follow-up visit will usually occur after 5-7 days post op. This is an important visit and the sutures will be removed at this time. Should there be a drain it may be removed at the same time if the discharge is diminished or disappears.

The compression dressing will be removed, depending on the healing of the operating wound and the presence of edema (swelling or fluid). In some cases the compression dressing will be reapplied for an additional 5 days.

Usually patients are not put on antibiotics, and only if there are any signs of infection or in complex cases will patients be put on antibiotics.

Neosporin and other antibiotic ointments are applied to the wound only as required (as superficial skin slough or slightly opened wounds).

Conclusion

Living a life free of Gynecomastia is the ultimate payoff for most male breast reduction patients. The benefits are well known. However, it is important to be educated about what the surgery entails and what the post-operative period will be like. We hope this guide has given you some insights into this critical period.

CLICK HERE FOR MORE INFORMATION ON DR. BLAU PROCEDURES

Case and point Peri/Keyhole/Gynecomastia are all really the same surgery and that is why and how they developed the procedure to be used on men like ourselves. Like I have stressed over and over again EVERY person man woman and in between have breast tissue it just how little we actually want. When tooooo much it taken out that leaves you with a concave contour. You have to remember that and also give the Dr. something to work with. Surgery is definitely 50/50 so keep up your end and they will do theirs. As well stress your concerns, wants, and needs because as they say a closed mouth does not get fed…

Until next time…

Salaam

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Comments
  1. It is great that you posted this so that other guys will have this useful info as well.

    • toyneboi says:

      yes sir I have to let things be known because there are a lot of people that go into this lost and some that never really reach out so at least they have something to kind of go by when they are looking into this procedure. I’ve seen a few get double just simple because there wasn’t enough information out there to help them understand what actually happens during peri/keyhole/gynecomastia surgery

  2. 1 Week Post Op and interesting facts about Peri/Keyhole ……

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  3. Reduce male breasts says:

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  4. Nathan says:

    Hey man,

    Thanks for posting this! I really want Peri surgery in the next few years (currently at school – need to save up!), but right now I’m focusing on improving skin elasticity. My size is right for the surgery style, but sadly, there’s sagging – too much of it. Knowing though that doctors, as you said, can be approachable and that you can tell them what you really want helps my conscience. 🙂 I’ll definitely keep your massaging tips in mind too! Good luck on the rest of your recovery.

    Nathan

  5. prasad says:

    Dr JB Ratti Vital Clinic — Male Breast Reduction, South Extention – 2, New Delhi, Delhi

    Location: South Extention – 2, New Delhi, Delhi, India

    S-Khan on Oct 7, 2010

    Review of Dr JB Ratti Vital Clinic — Male Breast Reduction (gynaecomastia surgery)
    I am writing this review for the benefit of anyone suffering from Gynaecomastia (male breast) and is thinking of undergoing a surgery for it. I have myself been a patient of gynecomastia and have undergone a surgery (5 years ago). However the doctor who performed this operation on me ( Dr. Anup Dhir , working in Apollo Hospital, New Delhi ) did not do a good job . He did not remove the glandular tissue completely and sucked out more fat (adipose tissue) from one side. This has left a visible asymmetry and puffiness in my pectoral area.

    In fact after the surgery when I regained my consciousness, I told him that I could still feel the glandular tissue by my fingers. However he told me that it was my illusion and that he had removed glandular tissue completely from both the breasts. He added that it must be the pipes to remove haematoma (fluid) that I can feel. However that was not the case and even after 5 years I still have that glandular tissue which Dr. Anup Dhir should have removed.

    As you know, Gynaecomastia is not a fatal disease but an embarrassing condition. All the time you remain obsessed with your unnaturally protruding pecs ( or tits ). This surgery performed by Dr Anup Dhir did bring lot of psychological relief. With clothes the condition is not that prominent anymore. However the imperfection in surgery ( asymmetry and puffiness ) is clearly visible bare chested.

    The lessons I learnt
    1) We Indians have this habit of equating Doctor with God. These days doctors are more of businessmen . Never trust your doctor blindly or believe in everything that he tells you. Ask questions and never stop probing till you get a satisfactory answer. If possible, take a second opinion or a third before going ahead with a particular surgeon. Remember, it is better to get a perfect surgery done in the first attempt. The revision surgery costs you more and has less chances of giving the desired results.

    2) Always keep a record of the receipts and estimates that the doctor provides you. If he botches up the surgery you can go to a Consumer Court with these proofs or ask him to do a revision surgery free of charge. Make sure that he includes post-operative charges in the estimates.

    3) Clearly ask him what results you can expect after he performs the surgery. Though no doctor would do that but do ask him if he can give in writing the result he is promising. See what he has to say.

    Having learnt my lessons the harder way, today I visited another cosmetic surgeon based in New Delhi ( Dr. JB Ratti , from Vital Clinic, South Extension, New Delhi ) for consultation on the possibility of a revision surgery. I had done a google search and his website looked impressive ( with all the photos of past patients and glands removed ).

    On visiting his clinic, I found that it is a small private setup. Nothing like a hospital or a clinic but looked more like a house turned into a makeshift clinic.

    My weight and height were recorded and I was made to pay a consultation fee of Rs 500/- beforehand. Please note, no receipt was given to me for this payment of Rs 500/- ( may be to evade tax or the responsibility)

    Conversation with Dr JB Ratti started on a positive note as he examined my chest (very casually though). I explained him what I wanted to achieve through this surgery and my apprehensions. He listened patiently. When I started asking him questions as to how he is going to replenish the excessive fat removed from my previous surgery he could not give a convincing answer. Told me to have faith in the doctor. My next question was if he is going to use the Canula Knife to suck out the tissue or remove the tissue using his scalpel. To this Doctor Sahab became defensive and personal. Called me “Confused” and interfering with the doctor’s procedure.

    In todays time when we have RTI (right to information) is it a sin for a patient to know what his doctor is going to do to him. These doctors give fancy names to their techniques “like Tumescent Lipoplasty ” to impress patients and charge hefty fees but are not ready to explain what it really is and how it is different from the regular procedure (which costs half the price)

    In fact his much renowed Tumescent techniques was nothing different from the usual procedure ( other than the fact it was performed under local anesthesia by injecting an anesthetic fluid ). Upon further probing he told me that even in this so called “latest” technique, he would be required to make a Semicircular cut in the areolar region (just like Dr Anup Dhir did 5 years ago ) and poke inside the Canula ( a needle ) from various angles to suck out the fat and tissues.

    So what is so special about it that I should expect a better result from my last surgery .
    The procedure remains almost the same other than the way of putting me to sleep (or keeping awake)

    Honestly speaking, I so desperately wanted to get rid of this Gynaecomastia ( devil’s lump ) that I was ready to ignore all these doubts and get along with the surgery. I asked him to fix up the date for the surgery to which he happily complied. As a formality, I asked him to give me a printed estimate of the cost involved in the surgery. To my surprise he categorically refused ( citing the reason that it is against his Company Policy ).

    In fact he did not even want to give me the rough paper he had used to quote me a hand written figure of Rs 50 thousand for the surgery (with no break up ) and 7 thousand extra for compression garment and blood test. He insisted that I should note it down in my own hand writing.

    Needless to say, he refused to give the cost estimate of the surgery on his Vital Clinic letter head. He said that only the final bill will be issued after the surgery is performed (though a part of the payment was required to be made in advance).

    It does not take lot of intelligence to guess what Dr. Ratti was upto. He was playing safe. In case something goes wrong during or after the operation then I ( or my family ) would not have any evidence against this doctor.

    I thanked the doctor for his time and left his clinic.

    Dr J B Ratti ‘s (Vital Clinic, New Delhi) opaque business practices failed to inspire confidence in me. It is hard to let anyone cut you open if you cannot trust that person.

    However I really cannot comment on his prowess as a cosmetic surgeon. He may be really good for he claimed to have performed 2000 such surgeries in the past and had photos as well to back his claim. However, now after meeting him in person I would think 2000 times before going under his scalpel.

    If you have been suffering from this condition called Gynaecomastia ( male breast ) then a good surgery can transform your life. But do not ignore the paper work.

    S Khan
    New Delhi

  6. prasad says:

    Please don’t ignore the above

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