Dt. Rashima Arora

Depending on the techniques used, surgery for gynecomastia leaves scars which are in different places, and they may be more or less visible or acceptable to the man. There is no such thing as truly scarless surgery for gynecomastia. Given time most scars heal well and will be barely visible. The choice of which technique is used and where the scars should be discussed with the surgeon carrying out the procedure. Each surgeon and each man considering surgery will have their own thoughts and preferences, so the options should be discussed and all parties can agree on one approach. Although uncommon, some men do unfortunately have problems with their scars, either during the early phase – such as bleeding or infection – or later after the procedure if the scars become hypertrophic or keloid.

There is unfortunately no way to prevent scar tissue after any surgery. The goal is to minimize scar after surgery. Gynecomastia surgery is not deemed medically necessary nor is the removal of the resulting scars, but many men suffer severe psychological distress making solutions essential. Scar tissue for procedures  including the perioareolar region for gynecomastia are usually barely visible but it can persist for many months till it heals in that way.

Scar tissue is the body’s normal way of healing and some patients have excessive wound healing and scar healing responses and this can lead to a hypertrophic scar. A hypertrophic scar is red and raised and itchy and generally responds to non-surgical treatments. Many scars do not heal with a hypertrophic scar responds and are flat on the surface, but there can be thick and irregular tissue underneath. This is again a normal process of wound healing and it tends to soften or remodel over many months. The perioareolar area has many ducts and glands, which may lead to increased inflammation and subclinical infection, which can delay wound healing.

 It takes a year for scars to fully mature but they never "disappear" but should also hardly be noticeable if placed along the areola border. The incision for gynecomastia surgery goes partly around the areola and at armpit in our technique. We at Elegance clinic, Surat do not put any extra scar on lower chest for gynecomastia surgery. The armpit incision is for entry for liposuction and it is well hidden in armpit line which is natural line happening at junction of trunk and upper arm. As it heals it usually is well hidden due to the change in skin texture and color. However, for some patients, a thick scar known as a keloid may form leaving the patient with a new problem that may make him still feel uncomfortable going shirtless.

Choosing an experienced Board Certified gynecomastia surgeon is your best bet in getting optimal surgical results including the healing of the incisions. We cosmetic plastic surgeons are well trained for better suturing for barely visible scar. We use layered suturing that too with very fine sutures. This differentiates cosmetic plastic surgeons’ scar from any other surgeon. We also do not put any scar outside chest area. We do not put scar on chest wall to as usually done by other speciality to get access to gland of gynecomastia.

Usually gynecomastia incision is not prone for such scarring. Some men produce more collagen than others during the healing process. It is the excess collagen makes a raised noticeable scar. This can be genetic or the poor suturing technique which can cause such bad scarring. Past history or positive family history for bad scar formation is a warning to go for such surgery as you also can develop bad scar for you. It is a patient’s duty to inform doctor regarding this type of healing issues.

I stress to my patients the importance of following all preoperative and postoperative instructions in order for them to get the best results. I have found compression vests and early re-mobilization are helpful adjuncts in the minimization of post-operative scarring. When it comes to the care of the incisions, I advise my patients to use special gels preventing hypertrophic scarring and regular massage of incision sites. After the healing of the incisions, silicone sheeting is used to control the formation of keloids. If the hypertrophy develops I use intralesional injection or Laser / radiofrequency for the management of the scar. In the first year after surgery (really the first six months) steroid injections can be very helpful in breaking down any scar tissue formations. After one year the success of steroid injections to reduce prominent scar tissue diminishes considerably as the bonding of the collagen in the scar tissue becomes very mature. There is no harm in doing further steroid injections but be aware that the success of them at this far out from surgery may not be like what had occurred earlier after surgery. Should this fail you should consider a small revision through an open incision under local anesthesia as an office procedure. This can remove the problematic small area of scar with little risk of recurrence.

You can expect to find a result in 9-12 months following the surgery. There are many treatments that can help accelerate these topical laser treatments on discolouration of the scar and then bulk heating radio frequency treatments to facilitate softening of the glandular area. These bulk heating radio frequency devices help remove the swelling and edema which contribute to firmness of the scar tissue as well as enhance tightness and contour.

  I think you have a high probability of ending up with an excellent result and it’s very important to follow-up with your operative plastic surgeon as they are in the best position for recommendations for post-operative care.