Puffy nipples only - amount of gland excision?

[puffynipsman]

Hello doctors,

First, thank you for answering all of our questions. This site is an invaluable resource for us men scarred by gynecomastia.

I've had puffy nipples since puberty and am now in my early 30s. I have very little fat on my chest and my BMI is 22.5 (5'8" and 148 lbs). The surgeon I've chosen is a Castle Connolly top doctor and is highly regarded when it comes to breast surgery for women. I've seen after photos his gyne surgeries and am pretty impressed with his results; I'm sure he would be able to give me a chest I've only dreamed of.

I do have some other questions for the doctors on this site. The doctor I've chosen said he will perform gland excision and a small amount of lipo, but the exact amount of lipo will be determined after I'm on the operating table. So far so good, right? During our consultation, he said he would leave some gland under the nipple--maybe 5-10mm worth--to prevent crater deformity. This seems like quite a bit of gland to leave on a thin patient such as myself. Does that sound about right to you? Is it generally okay to leave that amount of gland and create a flat male chest where the nipple retracts to a more normal size?

Also, just out of curiosity: do men without gyne tend to have a thin layer of glandular tissue under the nipple as well, as I may after my surgery, or are they completely glandless? I guess I'm asking because I'm looking for a result that will be as close to "normal" as possible. Living with this for almost 20 years, I want to make sure I do it right the first time.

Thank you again.

[puffynipsman]

Ah-ha! After much digging, I found an answer from Dr. Jacobs that answers much of my question.

At gynecomastia.org/smf/1/to-leve-some-gland-or-not/msg144504/#msg144504, he said:

Men who do not have gyne still have some gland behind their areolas -- it is just not too thick.  That is the way Mother Nature designed us.

When I do gyne sugery, I also do a combination of aggressive lipo as well as gland excision.  However, I thin the gland, leaving some gland tissue behind the areola to prevent cratering.

That makes me feel a bit better, but doctors--please feel free to chime in if you have anything else to add.

[Litlriki]

Your surgeon's description--5 - 10 mm--is reasonable.  The lower number is appropriate for leaner individuals and the higher number for patients with a little more subcutaneous fat.  The goal is to provide an even layer of covering over your chest muscles, and the thickness of that layer should be fairly uniform after the surgery.  If the tissue under the areola is thinned too much, fat flaps can be mobilized to help minimize any contour issue, but in very lean patients, there may not be much fat to use in such a circumstance.  The liposuction is used to provide a smooth transition between the area excised and it's surroundings, so even in lean patients, it's an important part of the procedure.

Rick Silverman