4 Months Post-OP, One nipple still puffy and protrudes.Scar tissue or gland?Help

[DepressionfromGyno]

My nipple on the concerning and puffy side looks like a sort of weird skin tag of sorts. It is also puffy when warm and protrudes heavily, and very responsive to touch or temperature. It behaves just like it did pre-op and it is very stressful and concerning. My right side is completely flat and flush with the chest after the surgery, unlike my left side. I am now almost 4 months post op, and I was wondering what is causing it to behave this way? Please help. 

I had noticed it was puffy like this around 5 days post op, but I had always assumed it was swelling.

What could be causing this puffy appearance and will the situation rectify and become flat/flush with the chest like my other side in the near future?

Attached below are some pictures showing my concerns: 

[DepressionfromGyno]

Here are some photos to show the contrast between my normal side and the puffy and protruding side:

[Miguel Delgado MD]

I have seen this happen, and it is frustrating for men.  The areola has a thin muscle that contracts and relaxes when cold or stimulated.  In your case, the muscle is contracting and "coning up," causing it to protrude from the entire nipple-areola complex.  It is not just the nipple if it was, this could be reduced to be nearly flat. Why one side did this and not the other is hard to say, but your surgeon did not do anything in error.  I have no solution for this condition except let it heal entirely for nearly a year.

[DepressionfromGyno]

I have seen this happen, and it is frustrating for men.  The areola has a thin muscle that contracts and relaxes when cold or stimulated.  In your case, the muscle is contracting and "coning up," causing it to protrude from the entire nipple-areola complex.  It is not just the nipple if it was, this could be reduced to be nearly flat. Why one side did this and not the other is hard to say, but your surgeon did not do anything in error.  I have no solution for this condition except let it heal entirely for nearly a year.

But what is causing the different size in areolas and it to puff out so heavily when relaxed or warm? When the muscle is not contracting and is relaxing, one nipple behaves like it was pre-op - puffing out. This is not a case of the muscle contracting as I am unsatisfied how it looks like when it is not contracted. When it is contracted, it looks invisible in the front. Is this just scar tissue?


The foremost pictures in the initial post were not contracted at all, and were relaxed and warm. Yet, it still is puffing out. I would much rather have it look how it is when it is contracted than have it puffy and puffed out the majority of the time. What can I do to rectify this and why does this happen?

[Miguel Delgado MD]

Each side is different. Surgery changes things even more. Sometimes there is no good explanation or correction for these issue. You can not control the nipples. Good luck.