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Revision surgery (direct excision) harder if previous surgery was lipo only?

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I had surgery for gyno years ago around 2006-2007 via sharp cannula liposuction alone.  It was not very successful.  Recently I've started thinking about getting surgery again.

While I'm convinced that direct excision is my only answer, I'm wondering if it's any more difficult for the surgeon or I'm a higher risk somehow because I had the previous surgery?  Would the breast tissue excised be "hole-y", or chances or the sharp cannula would not have penetrated at all?

Linkback: https://www.gynecomastia.org/smf/index.php?topic=29837.0

I only had lipo... despite my PS saying he'd excise the gland if need be. It actually exacerbated the problem, since I didn't really have any fat on my chest and it was purely glandular. So I had a revision a couple of months later, by an experience gyne surgeon and 4 weeks out I couldn't be happier with my results. When I saw the pictures of the glands removed, they looked solid, despite me having lipo 3 months earlier. You're probably in the same boat. I don't think you're at any greater risk because of the surgery and since he didn't do any excision, you likely don't have a tremendous amount of scar tissue built up that often fills in the gap when excision is done. I didn't. Just make sure you get it done right. I was annoyed I had to pay all over again, but ultimately, SO SO happy I did. Go to a specialist in the field. I can't stress that enough. I'm happy to post my pre, post, pre-revision and post revision so you can see what a difference it makes.

Thanks for the reply.  I actually am not sure about the amount of scar tissue i have.  I can definitely feel that "disc" of gland.  Sure I wouldn't mind seeing your pics if you haven't posted them already.  And yes, if I go through with surgery again, I'm definitely going with someone with a reputation. 

Though it's interesting about "reputation".  I used to frequent these boards years ago and a certain NY doctor had a stellar reputation around here then.  Now I'm seeing he's been banned for suspect reviews.  Goes to show... it's difficult to trust what you see on the internet, no matter how much research you do.

Revision surgery is always more difficult and less predictable due to the scar tissue present from the initial surgery.  Realize that the scar tissue is not just the scars on the skin surface-- there is scar tissue spread within the tissues all across your chest. 

In most, but not all cases, lipo alone is insufficient to achieve the best results.  In your case, going the opposite way of doing excision alone is also not the best idea either.  The concept is that appropriate removal of tissue is just part of the surgery -- you need to allow the skin to re-distribute and re-drape itself -- and that requires undermining (ie lifting of the skin off the underlying tissues).  Sometimes this is done with a liposuction cannula -- with or without suction -- but it needs to be done in virtually all revision cases.

Hope this clears up your situation.

Dr Jacobs
Dr. Jacobs 
Certified: American Board of Plastic Surgery
Fellow: American College of Surgeons
Practice sub-specialty in Gynecomastia Surgery
815 Park Avenue
New York, New York 10021
Telephone:  (212) 570-6080
Email:  dr.j@elliotjacobsmd.com
Website:  http://www.gynecomastiasurgery.com
Website:  http://www.gynecomastianewyork.com/revi


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