This will be my 4th Surgery. Is Nipple/Aerola removal ever done?

[Sne212]

I had my first surgery to correct gyno when I was 22.  I had a SEVERE case of Stage 3 gyno from age 13 and knew that lipo would not be enough to create the best result but I was 22 and went with my surgeon's suggestion.  The results were poor, so he then did a second surgery of sub Q mastectomy.  Removed some skin around the ariolas but my chest was so large I was nervous it would not be enough.  The results were better, but still had a puffy chest and nipples, just far less than before.   10 years later I found a surgeon with extensive gyno experience.  He performed a sub Q mastectomy and this time removed the gland and more skin.  This was a much better result and I've been okay with that for the last 23 years.  I'm now 54, have stayed in really good shape, but a recent run of finasteride to treat my prostate has resulted in a re-activation of gyno.   I've also experienced the loosening of the skin on my chest from both aging/gravity and the fact that I had a great deal of excess skin from the original gyno. 

My question for the doctors is can a surgery be done that would remove the nipples ariolas completely as well as a great deal of loose skin that was always there and has obviously gotten looser with age.   I've always hated my nipples/ariolas (and they've partially caved from the three surgeries and over time), I would just do the 3D tattoo nipples.  I also would gladly accept scarring from the skin removal if it would result in a nice tight contour.   I've attached current photos that reflect my current conditions.

Thank you for any input.

[Dr. Elliot Jacobs]

Sorry to hear of your travails with your gynecomastia operations.  Your photos do not look bad -- but then they are only photos and do not reveal what is there in person.

Yes, in rare circumstances, a surgeon could excise the nipples and areolas  in a horizontal ellipse which would encompass any lax skin as well.  The result would be a permanent scar horizontally placed on each side of the chest.  Theoretically you could then tattoo a nipple on the skin at any place of your choosing.

Honestly, though, you might do better with yet another operation to repair the craters and remove any residual excess tissue.  The skin might still tighten a bit but realize you are now older and have lost some elasticity and you also look like you have been in the sun a bit and that too would have diminished the elasticity of your skin.  

I would strongly advise you to seek the advice of a gyne expert in your area -- or consider traveling for such expertise.  You could then discuss the pros and cons of any contemplated surgery.

Good luck!

[Sne212]

Thanks for answering my question Dr. Jacobs.  The input is appreciated.

[Miguel Delgado MD]

I agree with Dr. Jacobs. You look very good.  Cutting off your nipples would deform you and tattoos look artificial, both defeating your purpose. I would suggest like Dr. Jacobs, crater deformity surgery with added contouring. I would also apply heat underneath the skin for additional contraction.  A peri-areolar lift can be done to excise a doughnut of skin around the areola 4 months later, for additional skin tightening. This can be done under local anesthesia.

[Sne212]

Thank you for your opinion Dr. Delgado.  So the peri-areolar lift is a technique used to tighten excess skin in the area?  Just curious if this is something that was utilized 30 years ago at the time of my initial surgeries or was it developed later on?

Thank you again.