An update on my thoughts about swelling and bruising after gynecomastia surgery:
The resources I have posted are typical for my patients. That is the ethical standard required by the Plastic Surgery Societies for details we put on our websites and show our patients. I take early after surgery pictures to document how my patients progress after surgery. Although no doctor can guarantee results, we consider any patient outside that range as something to analyze, understand, and improve upon.
Evolving surgery to minimize bruising and swelling is a goal to speed recovery. To understand if I am doing well, I started out by evolving a system of standard pictures so I could document the problem, the progression of healing, and then the final results. Videos became a higher level of analysis. I also evolved a careful documentation system to measure just what the deforming features were and what surgery did to address the deformity.
Then over the years, I would analyze each patient and try to understand how I could do better, get less bruising, less swelling, less discomfort, and a better result. The images had another value. I could use them to show what my patients experienced. Knowing what to expect can lessen anxiety. My goal of putting what i did up on the internet, was to have my patients tell me that their experiences came close or better than what they saw. I then took that analysis and evolve my surgical methods to what you see today. The scientific process is part of making surgery better. Careful documentation, analysis, evolution, then continue the process is key to making anything better.
The system worked quite well. My typical patient has peak swelling in the operating room. The tumescent swelling takes a few hours to several days to go down. But beyond that very subtle remaining swelling continues to evolve over the next 6 months or more. But now evaluate the documentation. Our process permits pictures the day after surgery and for those that come back, we take another set at about 6 to 10 days after surgery. We sometimes get longer term images when patients choose to return to let us see their progress.
I was also seeing so many patients unhappy after surgery done elsewhere complaining about deformity after surgery that I coined a term Puffy Nipple Complications with an analysis of my findings during revisions of these patients. A recent analysis of a few years came up with over 500 of requests for help after surgery done elsewhere.
I became involved with trying to understand why so many patients were asking me why they still had puffy nipples after surgery. That brought me to look for other doctors' early after surgery results. Not all doctors show how their methods evolve after surgery. That can make sense if their methods have more swelling or bruising. However, there is another way to see this sometimes. Do a search on this forum. Some patients of that doctor will put up early after surgery images. Here is the search function:https://www.gynecomastia.org/smf/index.php?action=search
in the field selection put the surgeon's last name in the search box, then check off both boxes
Show results as messages
Search in topic subjects only
You will get posts usually about a doctor and some may have images of what their patients may look like after surgery.
In my opinion, having typical pictures on a website is a powerful tool for any patient of that doctor to understand what they are in for after an operation. Lessening anxiety, understanding what to expect, how soon will you see the results is something better demonstrated ahead of time. If a method takes additional time until you see the result, it should be the job of any surgeon to help their patients understand the limitations and advantages of their techniques.
The methodology is not unique to gynecomastia surgery. Tumescent Tummy Tuck transformed the recovery process of what had been a painful slow recovery after cosmetic surgery of the stomach. Talking about the advantages with many of my peers, they also were finding the value of evolving methodology. For the Tummy Tuck, the picture and video sets are different than the gynecomastia, but the system transformed that surgery to something that my patients frequently find that they only need plain Tylenol for their comfort after surgery. That was unheard for an operation where papers and lectures were discussing pain pumps, local anesthetic pumps or injections, and other issues.
But back to the point at hand, the problem of how tissues evolve is still an issue for some doctors' patients. In the last day I saw at least 3 such requests for help here in the forum. Knowledge is power. Adding a demonstration of what any method is like can be a great value in lessening anxieties. Here is another typical example of which I have posted to this forum showing areola reduction issues by targeting gland first. But here instead is a progression of the documentation for that patient of only one view.
Puffy Nipples Tuberous Breasts Before Surgery
2 Days After Surgery
9 Days After Surgery
1 Month After Surgery
15 Months After Surgery
Now a single case shown here in this is not as effective as the combined grouping of that issue for many patients on my website. But that is the situation with the new forum rules. For a better demonstration, in my opinion, I prefer to be able to show my patients many examples of different types of gynecomastia surgery for different problems so the variation in my methods can be better documented.
Hope this helps,
Michael Bermant, M.D.