My question is for Dr Bermant. Regarding puffy nipple's post surgery
I can feel almost no gland in my chest and its now 5-6 months post surgery, yet my nipples are still puffy and protruding. I had both gland removal and mild lipo and I was clear with my surgeon that I had no issues with residual chest fat or my chest contour. He specifically said, "yes, your nipples will return to normal size" when I asked if the surgery would fix the protruding nipples. I'm now certain that the surgery infact increased nipple size and protrusion. My condition looks most like the 4th photo down, or the last photo on your "male puffy nipples" section.
Anyway, the question was in regards to your techniques. Im wondering if my surgeon removed both fat and gland, how come he could not get the same results as I see on your site. What is it that is actually causing the nipple to protrude? fat? residual gland? the way he shaped the residual gland? If i was to have another surgery, what would a surgeon such as yourself actually be doing? removing more fat? reducing the nipple size? reducing/increasing surrounding skin tension on nipple?
Thanks in advance.
/edit
After a bit more searching I found a relevant post. You say that residual gland behind the areola is the most common cause for the puff, although I cant find any gland perhaps it is just out of touch. What are other causes?
Just because you go to a museum and see the work by an artist you admire, it does not mean that you can go home and find someone close to you to create the same quality work you see in that painting or sculpture. Surgical sculpture is a skill, an art form that varies from doctor to doctor and hopefully evolves over their career with experience. Good surgery involves more than just wielding tools, it is a methodology for perfection that can only be approached, never completely achieved. The body is too much a variable for that type of predictability.
Many, many years ago I was trying to understand why I was seeing patients who did not look good in person yet seemed to be "fine" when the analysis was based on a few still images like frontal and side. Some of the individuals coming to me were done by the surgeons writing papers on their techniques claiming how great that method was, yet why were patients unhappy after this result and asking me for help? This led to my evolution of my Standard Pictures showing the contour from more angles and how the tissues look while being flexed and arms up overhead. It then was further refined with my Standard Videos. I included interval documentation to critically look at what path my patients were taking. I wanted less bruising, less swelling, less discomfort, and a faster recovery.
At the same time I worked on a documentation system of learning why the patients got that way (history) and what I did to achieve my sculpture in the operating room. I stood on the shoulders of John Tebbetts, a Texas surgeon who's paper documentation methods I admired and then took off and used his Rhinoplasty demonstration for other forms of my surgery.
The methodology involves defining the patient's problem, documenting the contour and animation contour issues, my observations based on those images when a Remote was used, documenting the exam in the office, and then documenting the after surgery results (with the limitations of patients traveling long distances for my surgery). Then evaluating what I did, what could be done better, and then evolving what I was doing.
I also began a campaign of public education changing the process of how my patients learned about the problems of the conditions I was treating, what my results offered and what complications I was seeing from other methods. This started many years ago when as a member of the Education Foundations Technology, Allen Van Beek asked me to learn what the internet had to offer Plastic Surgery. I did and my efforts resulted in my being honored by my society for my web site and public education efforts. That award is one of the most cherished achievements as of time of when I was given it, there were only 30 other Plastic Surgeons so honored. The names on that list are a who is who of surgeons i have emulated during my career and seeing my name on it has been mind boggling as it is published in the Society's directory and in each of our annual meeting's booklets.
Back to the methodology, once the documentation and basic education has been achieved, I then propose a plan for treatment. My goal of what is up on my site is for my patients to be able to tell me that their results were close to what they saw or better. Although no surgeon can guarantee results, these results and bruising swelling to get there are typical for my patients. When I get results outside of this, each case is analyzed and evaluated to see what happened, what can we do better, and how can that issue be prevented. That is part of experience and evolving each aspect. It is fun looking back at earlier documentation, pictures, operative reports, and methods and seeing what I current have evolved. That the process has not stood still, has been really fun. Years ago I challenged the techniques seen in the journals and began targeting gland first, evolving my fat flap for the hole I made, using resources thrown away by those sucking out fat first, and then getting something that looked better under a closer scrutiny of analysis of animation, flexing, moving tissues, and healing.
My analysis of the many unhappy patients after surgery done elsewhere then led to to define names for these complications, document what I observed during my revisions of these individuals, and demonstrate what I was able to achieve or in some cases, why I could not offer surgery as the deformity was beyond current technologies. One such entity is my defined Puffy Nipple Complication which really cannot be done justice without seeing these resources. There are many variations I have seen contributions to that complication. Some patients have one others multiple contributions that resulted in that problem. Yet other patients had combinations of deformities.
Part of this process is the education trying to prevent the problem. That is real hard when the public chooses surgeons with limited demonstrations of what that doctors' methods result in. Why go to someone with only 1 example before and after surgery, with only two views demonstrating the contours of that individual, and contours that are shown. If a patient gets what they see (or for that matter don't see because there are no examples), then who is to "blame." If those results represent what that doctor feels is "good," then do not hold that doctor to the results seen elsewhere.
So in your case, what is the problem, what is the solution? We are glad to help patients explore such issues during a consultation or our Preliminary Remote Discussion which is what our patients from afar use to minimize travel to Virginia. This will need our standard images for revision surgery, forms to be filled out, and preferably the operative report to optimize my understanding the current situation. If interested in learning more send a request with your email address and I can provide details and resources. Jane is my office manager and can explain the process. She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.
Hope this helps,
Michael Bermant, M.D.
Topic: For Dr Bermant (Read 2201 times)
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