The Question At Atlantic Coast Aesthetics, we get a lot of questions from patients who are concerned about the trajectory of their recovery or results after having cosmetic surgery done elsewhere. One example is the focus of this week’s Ask Dr. Pane segment. The viewer asks, “I’m about a week to ten days out from gynecomastia surgery, and there’s some puffiness. I think I may need more tissue removed. What do you think?” RealSelf Patient Reviews of Thomas A. Pane, MD

The Case Dr. Pane reviewed the before and after photographs the patient provided. Although the photos are not of the best quality, he was able to determine there is some swelling in the area, no visible excess or hanging skin. Patients should always remember that even the best photographs are not a substitute for an in-person consultation, and that the human body does require a healing window before results can be definitively seen after surgery. The Answer In this case, Dr. Pane says if the patient is concerned, there may be something going on, but at 7-10 days postop, the tissues are very much in the initial healing stage. It usually takes 3-6 months for the surface healing to completely resolve, and could take a year or more for the surgical site to fully finish scar formation. Taking this into account, it is simply too early to say for certain whether what the patient is experiencing is normal postoperative healing or if revision to the initial procedure may be appropriate. Another concern is the lack of information regarding exactly how the procedure was done, how much and what type or types of tissue were removed, what the stated benchmarks for recovery were and what the expected results should be. Without knowing these things for certain, it is difficult to properly evaluate the postoperative healing and determine if the patient’s recovery is on track, whether there are any issues and if so, what the appropriate resolution might be. This is because there is rarely a “one size fits all” corrective action which is useful in every situation for every patient, making the provision of a complete medical history a crucial component in effectively assessing the results of the surgery. If there wasn’t a great deal of tissue removed to begin with, Dr. Pane says normal postoperative swelling and irritation in the area caused by the surgical insult to the tissue may make it appear as if nothing was done at all, especially when the patient is wearing clothes. As the healing process proceeds and the swelling begins to subside, the tissue should resolve to a flatter chest profile. If there was a great deal of tissue removed, that may speak to a different issue which the patient should address with the surgeon who did the initial procedure quickly. In any case, if the patient does end up needing a revision, Dr. Pane says that from the pictures he sees no reason this could not be done, although this soon after the initial surgery it is simply too early to state anything definitively. Your cosmetic surgeon and/or support staff should give you a list of normal postoperative effects and potential complications to be aware of, either immediately before or just after surgery. Some common warning signs of postoperative complications which require immediate attention include:

• Abnormal pain. While some discomfort and aching are to be expected, sharp, stabbing or intolerable pain is not typical, especially if the patient is using painkillers and the pain persists.
• Infection. A certain amount of redness and/or swelling is normal. However, if the area appears “angry,” begins weeping yellow or green fluid, especially fluid accompanied by a foul odor, feels unusually hot to the touch or begins to swell rapidly, these may be signs of infection.
• Ruptured sutures. Depending on the location and the time after surgery, these may or may not be a problem. However, especially for the first several weeks after surgery, a ruptured suture may lead to infection or improper wound healing.

If you experience any of these symptoms, you should contact your surgeon, primary care physician and/or go to the nearest urgent care facility. At Atlantic Coast Aesthetics, we welcome the opportunity to discuss your interests, concerns and questions, and invite you to ask us anything you’d like to know about cosmetic surgery! Simply call us at (561) 422-4116; follow us on Facebook, LinkedIn, Twitter and Instagram; or email us through our contact page. Your question might even be the focus of the next Ask Dr. Pane segment, helping us inform and educate others who share your interests. Remember, at ACA we believe the only bad question is the one you don’t ask!