Making areola's smaller

[Xavier]

Gentlemen....

As some of you might know, I already had surgery for a rather extreme case which required nipple replacement and skin reduction.

I'm not that satisfied with my result but it's better than how it was. I am approaching the 6 month post op mark and I am thinking of having a 2nd surgery later this year or next year. I want to remove some extra tissue and lastly make the areola's smaller.

Is this possible? Would there be more scars as well?

[Dr. Elliot Jacobs]

Making an areola smaller in diameter is very difficult -- and it is all about blood supply, anticipated scarring, etc.  It's complicated!

Sometimes the best way to make the areola smaller is to perform a free nipple graft -- taking off the nipple, trimming it to a smaller diameter and then replacing it on the chest.  But during the process, the skin will have to be tightened as well.

Did you have a skin excision and free nipple graft? How was your surgery performed?

Dr Jacobs

[Litlriki]

It would be helpful if you posted some photos.  It's possible to do areolar reduction, but depending on what was done previously, caution is required to avoid compromise to the blood supply of the nipple. Otherwise, the option of a free nipple graft, as described by Dr. Jacobs, would be an alternative. 

Rick Silverman

[DrPensler]

I would concur with the previous comments.Some photos and a better description would be useful.In severe cases or with free nipple grafts the subsequent options may be limited by the prior surgery.

[Xavier]

Doctors...

Here is a picture of the left side.. And yes, I did have skin removal and nipple replacement.



Here's a better picture:

[Dr. Elliot Jacobs]

These close-up photos look quite good.  It would be helpful if you could post some photos of yourself prior to surgery and then after surgery (full front views of your chest).

Dr Jacobs

[Xavier]

Prior to surgery



Just took these 2 pictures after tanning and showering. My nipples look quite smaller after showering or when I am cold. I'd like them to be this size or smaller. I'm almost 6 months post op and I'm not that happy with the results although it's a great improvement. I want to drop some more bodyfat to see what my chest will look like then.

[Litlriki]

One of the issues with your result is the vertical scar under the areola, which has the purpose of creating a conical shaped breast for women, but has no real purpose in a male breast reduction.  The result is that your chest isn't as flat as it could be, and the nipples still project a bit.  I'm not sure how best to deal with this issue based on the photos.

RS

[Dr. Elliot Jacobs]

Agree with Dr. Silverman's comments.

Your scars resemble a vertical breast reduction technique, which is used for female breast reduction.  One of the advantages of this technique, when used on a female, is that it enhances projection of the breast.  Unfortunately, that is quite the opposite of what men with gynecomastia usually seek, which is a flat and contoured chest.

Treatment of extreme cases, such as yourself, demands that the surgeon truly understand a man's goals, which is a taut, flat and contoured chest with a properly positioned nipple.  I have occasionally seen breast reduction techniques that are used for females transferred for use on a male.  This appears to be what was done in your case.  The predictable result would be residual tissue and skin, which you now evidence.  Suggest you have a conversation with your surgeon to explore additional options for improvement.

Bottom line:  techniques used for male breast reduction are different from those used for female breast reduction.

Dr Jacobs

[Xavier]

Agree with Dr. Silverman's comments.

Your scars resemble a vertical breast reduction technique, which is used for female breast reduction.  One of the advantages of this technique, when used on a female, is that it enhances projection of the breast.  Unfortunately, that is quite the opposite of what men with gynecomastia usually seek, which is a flat and contoured chest.

Treatment of extreme cases, such as yourself, demands that the surgeon truly understand a man's goals, which is a taut, flat and contoured chest with a properly positioned nipple.  I have occasionally seen breast reduction techniques that are used for females transferred for use on a male.  This appears to be what was done in your case.  The predictable result would be residual tissue and skin, which you now evidence.  Suggest you have a conversation with your surgeon to explore additional options for improvement.

Bottom line:  techniques used for male breast reduction are different from those used for female breast reduction.

Dr Jacobs

Is there anything you could do for me then? Because I will be in the States next month and I could come to NY for a consultation.

[Dr. Elliot Jacobs]

I would certainly be willing to see you in consultation.  It would be extremely helpful for you to bring a copy of the operative report from your surgeon.  In it, he would describe the procedure that was done.  What is most important is to know what technique was used for preservation of the blood supply to the nipple.

Dr Jacobs