Finally, there is the situation where the initial results of surgery appeared to be excellent – the chest is smooth and contoured and has nipples which lie flush with the surrounding skin. This would indicate that appropriate surgery has been performed and that all excess tissues had been removed. And then, weeks to months after surgery, there seems to be a firm lump (usually directly under the nipple) which the patient may believe is a re-growth of breast tissue. In these circumstances, given a normal appearance directly after surgery, it is most likely due to the growth of scar tissue and not a re-growth of breast tissue. The exception to this is if the patient has post-operatively used anabolic steroids, Propecia or any other medication which can cause growth of breast tissue. If however, the chest never appeared satisfactory after surgery, then inadequate removal of sub-areolar tissue is probably the cause.
When the growth of scar tissue is suspected, revision surgery may not be needed. Rather, an injection of a cortisone-like medication (Kenalog, for example), will gradually “melt” away the tissue. Occasionally, more than one injection may be required. These injections work over a period of about six weeks. Therefore, injections should be spaced at least 6-8 weeks apart. Kenalog injections can be done any time after the problem arises: several months or even years.