After male breast reduction surgery, if a lump is felt weeks or even months later, the natural reaction is the breast tissue has grown back. Unless the patient has been taking anabolic steroids, Propecia or other substances that may cause breast tissue growth, it is most likely the formation of scar tissue. Scar formation is normal after any type of surgery and generally takes 4 to 12 weeks to form.
If there is puffiness early in the recovery, it could be residual swelling or possibly not enough tissue was removed, but it would not be scar tissue.
When the initial results appear to be excellent, most likely the right amount of tissue and fat were removed. However, if the patient notices a firm lump most likely under the nipple, and it is determined to be scar tissue, revision surgery probably is not necessary. The surgeon can inject cortisone, like Kenalog, that will gradually dissolve the scar tissue. Sometimes more than 1 injection is needed.
Gynecomastia surgeons are very careful not to remove too much tissue, or the result may be a “crater deformity.” In the unfortunate situation where not enough tissue removed, or too much, gynecomastia revision surgery will be needed. The scarring in these cases can be problematic, and require the expertise of a gynecomastia specialist. The scar tissue from the original surgery makes the dissection more challenging, and the scar tissue will impede the contraction of the skin.