How puffy nipples can be fixed

[flatness13]

This is about the appearance of puffy nipples. Question is, does the surgeon have to remove certain tissue very specifically underneath the nipples(I think it's called 'ground zero') to fix it, or are there cases where puffy nipples can be fixed without doing that and the surgeon just removed glands generally?

[Dr. Elliot Jacobs]

Puffy nipples are due to breast tissue directly under the areolas -- which pushes it up.  The only way to permanently fix puffy nipples is to remove that excess tissue.  Seems easy -- but it isn't.  Too much removal can result in a crater and inadequate removal will leave residual puffy nipples.

I have operated on thousands of puffy nipples and every case is delicate.  However, at the end of the operation, the chest must be flat and the areolas must lie flat and flush with the surrounding skin.  And they must stay that way as well -- throughout the entire post-op healing.  Anything less than that indicates inadequate treatment of the original problem.

Dr Jacobs

[flatness13]

I see. So it's almost like it's two seperate surgery types when it comes to breast tissue..

Also on an unrelated question I've been really curious about, doc. When you operate on the patient he's lying on his back which is when gravity makes the chest look flatter. How do you predict how much tissue to remove when you know that the chest doesn't look like that when standing on our feet?

[Dr. Elliot Jacobs]

Excellent question and I will answer with an anecdote.

Many years ago, when I was doing some training in general surgery, I was scrubbed on a breast cancer case with a well respected senior general/breast surgeon.  We were doing a radical mastectomy (which is now virtually never done).

After the incision, the surgeon worked his way down to the chest way muscle and with several gentle sweeps of his scalpel, was elevating the tissues off the pec.  He was doing this casually and with the greatest of ease -- and the tissue just peeled away smoothly with nary any irregularity and with no bleeding at all.

Aways eager to learn, I asked him, "How do you do that so well?"

And he replied, "I just cut on that fine white line."

So I looked and looked and couldn't find any white line.  "Sorry, sir, but I don't see that white line -- could you point it out to me?"

He turned to me, smiled under his mask, winked and said, "Son, you cut on the fine white line of experience."

'Nuf said.  Now you know,  And that's why I have been urging guys who are contemplating this surgery to do their homework and look for experienced gyne surgeons in their community.

Dr Jacobs