« on: May 21, 2011, 06:57:22 pm »
Many patients have questions about swelling after surgery.  I would therefore like to add some personal perspectives on the issue.

All patients swell to some extent after surgery.  Swelling can sometimes be so severe that the patient initially thinks that nothing was done and that his gyne is still there.

Some of my younger patients are quite impatient -- thinking that they are looking at the final result of surgery just a few days or weeks after the operation.  Actually, it takes many months for the body to fully heal and for all the swelling to subside -- and this varies from patient to patient.

Surgery is a controlled form of trauma -- but it is still trauma.  And the body reacts to any trauma by swelling.  Swelling is a prolonged process which starts as soon as the surgery itself starts.  It does not peak during or at the end of the operation.  Rather, it tends to increase over several days and then slowly subside over time.  The literature often mentions a peak at 48 to 72 hours after surgery -- but I have seen substantial variation on that.  There is no surgeon whose technique can guarantee "no swelling and no bruising".  True, careful technique can minimize swelling  -- but swelling always occurs and bruising is very common.  

As for bruising, it is very much unpredictable.  Some patients bruise and others don't.  There are so many variable factors that it becomes impossible to predict who will bruise.  One thing is certain, however.  All bruising is temporary and harmless -- it always disappears.  I therefore tell my patients to ignore any bruising and just look at the contours.

Swelling after gynecomastia surgery is frequently asymmetric -- one side slightly larger than the other.  Welcome to the world of surgery -- where an identical procedure can be performed on each side and yet each side reacts differently.  Most of the time, minor differences are normal.  If there is a major difference in size, though, your surgeon must be notified. What must be ascertained is whether there is fluid and/or blood causing the major difference in size.  This is best evaluated by your own surgeon.  Some tip-off's which would merit concern:

  • much more pain on the swollen side
  • much more bruising on the swollen side

    Understand, however, that even a surgeon can sometimes have difficulty in determining whether there is overall swelling or an actual accumulation of fluid.  It is virtually impossible for a patient to determine this.  Occasionally a surgeon will insert a needle  into the swollen area.  If no fluid returns in the syringe, then it was swelling only and not an accumulation of fluid.

    If swelling is due to a collection of blood (a hematoma), then the surgeon will have several options based on the individual patient circumstances as well as the experience and training of the surgeon.  Options include:

    • watchful waiting
    • serial aspiration with a syringe over time
      • return to the operating room to evacuate the hematoma

        Swelling, in general, tends to take many weeks to totally resolve.  Any additional insult to the operated upon area, such as increased activity, exercise, not following your doctors recommendations, may actually prolong or even increase swelling.  Remember, the body doesn't stop from wanting to swell for several weeks at a minimum. That is why I usually recommend to my patients that they:

        • avoid all strenuous exercise for four weeks after surgery
          wear their post-op compression garments for a minimum of four weeks after surgery -- or even longer if possible and tolerated
        • wear their compression garments when returning from the gym (after the four weeks)

          I do hope this info has been helpful.  If you have specific questions about post-op swelling, you should obviously return to your surgeon.  He knows exactly what was done and is in the best position to answer your questions.

          Dr Jacobs

Linkback: https://www.gynecomastia.org/smf/index.php?topic=23295.0
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:  [email protected]
Website:  http://www.gynecomastiasurgery.com
Website:  http://www.gynecomastianewyork.com/revi

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