Puffy nipples: How to know when lipo is necessary?

[puffynipsman]

Hello doctors,

I'm a 29 year old male who has had puffy nipples since puberty. I'm 5'8" and 148 lbs. I have a very small amount of fat on my chest (more on one side than the other) and overall am fairly physically fit. When I was extremely active in my early 20s, I was down to 140 lbs and had almost no extra fat on my chest, but my nipples remained the same size.

I'm thinking about finally having surgery to fix my puffy nipples. I thought it would just be a matter of removing the hard glandular tissue beneath each nipple, but reading through some posts on here and other sites, it seems like lipo is sometimes necessary to prevent crater deformities.

So, my question is, when I go to a consultation with a surgeon, how will he know whether or not I just need the glands removed or if I need lipo as well. If he says he can just remove the glands and everything will be fine, how will I know he knows what he's talking about? Are there any questions I need to ask him to make sure the results are acceptable? The last thing I want to do is spend a ton on surgery only to be let down by the results. I can provide photos if necessary.

Thanks for your help.

[Dr. Elliot Jacobs]

Most often, puffy nipples on a slender person consists of concentrated breast tissue directly below the areola.  This, in turn, stretches and spreads out the areola. 

If a surgeon just removes the excess breast tissue, the stretched out areolar skin may tighten somewhat but is also restricted to the area of excision.  In cases such as this, I use my lipo instrument (cannula) but without suction to loosen the surrounding skin and tissue to allow for additional skin tightening.  On the other hand, if there is some fat surrounding the puffy nipple, then I will do some lipo as well.

You should inquire of your surgeon about his technique.  Not all surgeons are well versed in gyne surgery -- choose wisely.

Dr Jacobs

[DrBermant]

Hello doctors,

I'm a 29 year old male who has had puffy nipples since puberty. I'm 5'8" and 148 lbs. I have a very small amount of fat on my chest (more on one side than the other) and overall am fairly physically fit. When I was extremely active in my early 20s, I was down to 140 lbs and had almost no extra fat on my chest, but my nipples remained the same size.

I'm thinking about finally having surgery to fix my puffy nipples. I thought it would just be a matter of removing the hard glandular tissue beneath each nipple, but reading through some posts on here and other sites, it seems like lipo is sometimes necessary to prevent crater deformities.

So, my question is, when I go to a consultation with a surgeon, how will he know whether or not I just need the glands removed or if I need lipo as well. If he says he can just remove the glands and everything will be fine, how will I know he knows what he's talking about? Are there any questions I need to ask him to make sure the results are acceptable? The last thing I want to do is spend a ton on surgery only to be let down by the results. I can provide photos if necessary.

Thanks for your help.

I have posted How to Choose Your Gynecomastia Surgeon Here:

http://www.gynecomastia.org/smf/index.php?topic=16474.0

Puffy Nipple Gynecomastia Surgery is an art form, not all doctors have the same skills. You are picking a surgical sculptor, checking the before and after pictures / movies is necessary if you are looking to see what that doctor offers. Anybody can claim to be able to do something, the proof is in the results they have achieved, what is that method's revision rate by that doctor done himself / herself, how many patients then have revisions done elsewhere. 

My sculpture has evolved over the years. Although a normal male chest will have a tiny amount of gland, it should not show when the areola muscles relax and in motion. A chest should look good beyond just a few still pictures. How it moves when playing sports, exercising, flexing are critical.  It does not take much gland to distort the male chest. Residual gland and scar move like gland and scar, fat moves like fat. 

I prefer my Dynamic Technique where, what I find during surgery helps guide what needs to be done.

When gland is present, and it usually is, I prefer to start with and target the gland first. By concentrating on gland, I target the tissue that compresses the least and reserve the remaining fat as a potential tool for my reconstruction. 

Liposuction is fine for fat.  However, all forms of liposuction

• sharp cutting cannula
• ultrasonic
• vasor
• power assisted
• "smart"

all preferentially remove fat over gland.  Check out the Normal Anatomy of Gynecomastia.  When fingers of fat are between fingers of gland, liposuction alone tends to suck out the fat condensing  the gland behind making a mess. 

When significant gland is present, I start at the edge of the chest skin areola interface. That is a great place to fool the eye about a scar. Typically for normal gynecomastia, I need only one small incision on each side often about 1.6 cm (a little over 1/2 inch). This is much better than needing 4 incisions.  Direct access to the gland gives me direct access to controlling hemostasis (bleeding). This is a major factor in minimizing Bruising and Swelling with my Gynecomastia Surgery and why I can post such Early Healing After Gynecomastia Surgery Pictures.  Less swelling and bruising often results in greater Comfort After Gynecomastia Surgery.

Liposuction is but one of many tools of my artist's palette for surgical sculpture of the male chest and gynecomastia.

• Excision,
• Liposuction,
• Microliposuction,
• Nipple Sculpture,
• Mastopexy Male Chest Lift,
• Skin Reduction,
• and other techniques.

My Fat Flaps can bring fat into a crater.  A flap is tissue moved with a blood supply.  Adjacent fat transfered with a blood supply tends to survive, much better than a graft.  When carefully done, fat flaps tend to look like normal fat, feel like normal fat, and move like normal fat.  There are limitations to what fat flaps offer since fat still connected to its blood vessels will move only so far.

Try to go through the entire section about male chest sculpture on my site to learn what my techniques of surgery have to offer.

When liposuction is used first, a hole is often dug in the fat making a "flat" contour.  But the firmer gland does not compress like the fat causing distortion. In addition, techniques that target the gland remotely need to come at the gland from the gland edges and often leave a layer of gland under the areola that can look bad when the areola muscle relaxes and on animation.

Here are just a few of the many examples I have seen and treated:

Revision Gynecomastia After Failed Liposuction By Other Surgeon

Revision Puffy Nipple Gynecomastia After Failed Liposuction By Other Surgeon

Revision Gynecomastia After Liposuction and Partial Gland Excision By Other Surgeon.

Yes, there are many more examples of this technique on my website.  Gland targeted first and almost all removed, the surrounding fat replacing that gland.  I have never seen a crater deformity from my sculpture. 

The technique does not stop in the operating room.  Patient education, after surgery care, Compression Garments, Scar Care are but a few of the attention of detail that permits our patients to have maximum swelling at the time of surgery, quick recovery, and move on with their lives. 

You will not find many of my patients on the forums to answer your questions.  A few post but then disappear putting their gynecomastia behind them.  However, there are many patients who have been willing to share their gynecomastia surgery experiences on many pages of my website and in this forum.  (Start at the first page and then follow the arrows).

But in the end, each surgeon has the methods he / she prefers. It is the result that counts. But that should be a result

• that a patient does not need to keep his arms down or not flex his muscles to hide deformity,
• a result that looks good from many different views and looks good even on animation while living life no longer hiding the chest with clothing,
• and a result that does not typically need so much bruising, swelling, and discomfort to get to the other side.
  

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[puffynipsman]

Thank you for your replies doctors. I had my first consultation today, and it was with a FEMALE plastic surgeon in my area. She's well-respected and although I was a bit leery of a female gyno surgeon, she seemed to know what she was talking about.

I was extremely relieved to hear her bring up crater deformities and how she planned on avoiding them. She said that since fat doesn't seem to be a problem in my case, she'd remove the breast tissue under my areolas and taper the craters' edges and remove some surrounding fat/tissue as necessary to make sure the skin lays flat during healing. She said she wouldn't need to do this via lipo but rather just with her regular tools. I believe she used the word feathering but I could be mistaken.

Does this sound like a good technique to either of you? I have not committed to her yet and am planning on seeing at least two other surgeons before making a decision.

Thank you again for your help!

[DrBermant]

Thank you for your replies doctors. I had my first consultation today, and it was with a FEMALE plastic surgeon in my area. She's well-respected and although I was a bit leery of a female gyno surgeon, she seemed to know what she was talking about.

I was extremely relieved to hear her bring up crater deformities and how she planned on avoiding them. She said that since fat doesn't seem to be a problem in my case, she'd remove the breast tissue under my areolas and taper the craters' edges and remove some surrounding fat/tissue as necessary to make sure the skin lays flat during healing. She said she wouldn't need to do this via lipo but rather just with her regular tools. I believe she used the word feathering but I could be mistaken.

Does this sound like a good technique to either of you? I have not committed to her yet and am planning on seeing at least two other surgeons before making a decision.

Thank you again for your help!

Each surgeon has his / her own techniques for surgery. The proof is in the result and how they get you there. You should check for many before and after surgery pictures / movies, what tissues look like early in recovery, how much pain that particular doctors' patients are during recovery, and other factors covered here:

http://www.gynecomastia.org/smf/index.php?topic=16474.0

I personally feel that my Liposuction During Gynecomastia Surgery is a critical element of fine sculpture for my Dynamic Chest Sculpture. Not having it available would be like having one hand behind my back for the operation.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[Dr. Cruise]

If you are very thin, liposuction may not be necessary.  This is something that really has to be determined during your consultation.  Be sure to have your procedure performed by a surgeon who has a lot of experience in gynecomastia.