Is the procedure done the same for puffy nipples?

[Timmy31]

Hello Dr.s,

first I'd like to thank you all for taking the time to come to this forum to answer our questions. I have surgery coming
up at the end of this month, and so I've been doing a lot more reading in this forum, just to hear more of other guys
experiences. My question is are puffy nipples a bit more of a risky procedure than just your typical gynecomastia?
(guys who just need excess fat and gland removed from under there chest). I've been reading posts in the puffy nipple
section of this board and it seems quite a few guys have problems with the puffiness coming back or not totally being
removed. with me I have excess fat/gland and puffy nipples. So I am concerned. I don't know if I'm getting cold feet or
what, but I just want to make sure I have just as good of a chance for successful surgery as those who don't have the
puffy nipple problem. Dr.s can you please help to understand this better and really let me know what I should expect?

[George Pope, M.D.]

The puffy nipple appearance comes from breast or "gland" tissue pushing the areolar skin forward from behind.  When the smooth muscle fibers in the nipple/areola area are contracted, the tissue tightens somewhat, and the puffiness goes away, or at least looks better.  When the smooth muscle fibers are relaxed, the gland tissue is able to push forward and create the puffiness.

This is corrected by removing the gland tissue, usually under direct vision through an incision on the underside of the nipple/areola.  Liposuction is not successful in removing true gland tissue.  The important point is, you have to save enough tissue behind the nipple/areola skin to support the skin and prevent a crater deformity.  There is a fine line walked between taking out enough gland tissue and taking out too much.  It all comes down to experience in the operating room, which is why it's important to select a plastic surgeon who has a special interest in gynecomastia surgery and does this surgery all the time.

Liposuction is often performed in conjunction with the gland excision, as you probably already know.  Most gynecomastia patients have true breast tissue or gland that is easily palpable, and some or most guys will also have some excess fat that should be suctioned away as well.

Dr. Pope, MD

[Timmy31]

Thank you Dr. Pope for explaining this to me.