location: Transition > Chest Surgery > Revision Surgeries
Ever since my original chest surgery in August 2003, the right side of my chest has been different than the left. I developed a hematoma and had to get it drained twice over three days to remove about 190ml of old blood/fluid. Despite my efforts in physical therapy, ultrasound therapy, going to the gym religiously, and waiting, the right side is still noticably different than the left. Although most people say they can't see it, it is still a constant source of self-consiousness for me.
In March 2005, I saw my original surgeon Dr. Menard to ask him about a revision. He said I should wait another year to see if it would go down on it's own any, though it might just be fibrous tissue from the hematoma. He said he could remove some of the underlying fashia via scapel (it may be too thick for a liposuction needle) from the right side under local anesthesia for $600 if after a year it still hadn't resolved itself. So, in April 2006, I contacted his office about setting up another consultation and possible surgery date. They requested photos, and although it is hard to see the difference in them, I sent them the best photos I could take:
Right - Seeking Revision
Although you can't tell from these photos, my nipples are also not even (they weren't before surgery either). When I saw Dr. Menard in March 2005, he said he could also raise the left one, but that would mean losing the hair-growing skin there. At this point, I think losing that hair would probably look funnier than them being a little on different levels so I don't think I'm going to have that done.
I had a revision consultation in early June 2006, and Dr. Menard said he would like to try to even out the right side using liposuction under local anesthesia. If he is unable to remove it with liposuction, he said he will have to open it up, but he will try to use the same incision site as my original surgery. I had a revision scheduled for late-August 2006, but had to cancel it due to getting into graduate school last-minute.
In December 2007, I found out I needed to have a revision on my bottom surgery. I decided to pursue getting my chest revision done at the same time, in order to minimize the number of times I have to go under anesthesia. I consulted with a plastic surgeon at the hospital where my bottom surgery revision was going to take place, and he agreed to do the chest revision at the same time as my bottom surgery revision. He said he could use the original incision line to even out the right side of my chest using surgical excision directly under the nipple and liposuction for the area more on the side/under my arm. Since I needed a plastic surgeon (him) to be involved in my bottom surgery revision to do a muscle graft anyway, he would do my chest revision as a kind of "side project," and he would try to get insurance to cover it (condsidering his services were going to be involved in my bottom surgery revision already). I had my chest surgery revision, occuring simultaneously to my bottom surgery revision, on March 10, 2008.
Unlike my original surgery in Montreal, I did not have a drain after the surgery. My plastic surgeon said he didn't think I would need one. When I woke up, I had a "pressure bandage" on the right side of my chest. At 5 days post-op, I noticed that when I pushed on the area next to my sternum, I heard a bubbling noise, as if I was pushing on a bag of water. It was difficult to judge if it had increased in size/swelling, as the pressure bandage was rather thick in itself. Still, this being the first presenting sign of my last hematoma, I called the plastic surgeon resident on call. I told him the situaiton, and he basically told me not to worry. I began wearing the binder I bought just in case at 4 days post-op (my surgeon said I didn't have to wear it, as he didn't think I would need it either, but I began wearing it when I started to worry about fluid accumulation).
At 8 days post-revision surgery, I saw my surgeon for my first post-op appointment. Despite having worn the binder, I had developed another hematoma, and he drained 45 mL of blood from it. I saw my surgeon again a week later (15 days post-revision), and the hematoma had gone down enough so that he did not want to try to aspirate it again. There is still have some swelling and scar tissue under the nipple/areola complex, creating a bump similar to what was there before the revision surgery. Wearing a binder hasn't seemed to make any kind of lasting difference. While this is currently frusterating, at my third post-op appointment (43 days post-revision) and fourth post-op appointment (85 days post-revision), my plastic surgeon said this bump area under the nipple-areola complex was scar tissue that should continue to flatten out with rigorous and continued massage. I tried this method for a while, but it just didn't seem to go away. At 10.5 months post-1st-revision, the end result of the 1st chest surgery revision was:
Post-1st-Revision - Front View and Right Side
In January 2009, I found out I needed to have another bottom surgery revision for a small fistula and to replace the testicular implants with tissue expanders (which would be expanded over time to stretch the scrotal skin, then replaced later with new testicular implants). My plastic surgeon offered to remove some of the scar tissue that built up from the post-revision hematoma during this surgery, combining this (2nd) chest surgery revision wtih the 2nd bottom surgery revision, similar to how the 1st chest surgery revision was combined with the 1st bottom surgery revision in March 2008. This time, he will put a drain in to try to help prevent another hematoma.
At this 2nd chest surgery revision, on February 4, 2009, the plastic surgeon again used the same small incision around the bottom half of the right areola. He removed the scar tissue from the previous hematoma, and placed a Jackson-Pratt (JP/Bulb) drain, the same type of drain I had after the original chest surgery procedure in Montreal in 2003. I had the drain for a total of six days, and not much drained out, perhaps a total of 40 ml or so (the vast majority within 24 hours of surgery). I wore a chest binder for 12 days, after which it was clear that I was out of the woods for developing another hematoma. This revision was also paid for by insurance since it was combined with my 2nd bottom surgery revision.
Post-2nd-Revision - Front View and Right Side
Finally no more hematoma or fibrous scar tissue lump!