My biggest concern of surgery - noticeable scarring.

[Teenaged]

I have a relatively mild case of gynecomastia.  However, I'm very fit, so my puffy nipples definitely stand out.  I am considering getting surgery to have the glands removed, but I am worried about noticeable scarring following surgery.  I'm trying to gauge which would be more embarrasing: having puffy nipples, or having scars that make people aware that I have had cosmetic surgery to remove the puffy nipples. 

I am also having a hard time finding pictures of VERY close up pics of scars from the surgery.  Can anyone give me some more information on the scarring and how noticeable it is generally.  Also, if the scar doesn't subside within a say a year, is it most likely going to look that it does forever? 

Last question - I'm considering have surgery with a Dr. who is about 5 hours from my home.  He offers a $125 consultation that can be done by email for patients who are from out of town.  Is it really important to have the consultation in person, or is it ok to have it over email by providing pictures and information to the surgeon? 

I hope you guys are able to provide me with some answers.  I am highly contemplating surgery, but I don't want to go through with it, if I will have noticeable scars the rest of my life.  Thanks...

[Dr. Elliot Jacobs]

I have found that adequate treatment of puffy nipples usually requires a small incision around the edge of the areola.  That is needed to gain access to the gland beneath the areola and to be able to remove it very precisely.  That incision will leave a permanent scar -- it is the price to be paid for the procedure.

That being said, these scars tend to heal (in time) so very well that is is very difficult to see them.  Of course, part of how a scar heals is due to how precisely the surgeon sutures the incision and how well you take care to follow the surgeon's post-op care instructions.  But Mother Nature does rear her head here -- your body's tendency to heal (which is genetically determined) is also a factor.

To put it bluntly, though, I have never had a complaint about a peri-areolar scar from any one of thousands of patients who have had this operation.  They all gladly trade the scar for a better shape.

As for email consults -- yes, they do work.  I have many patients who I evaluate over the internet.  But bear in mind, the very best evaluation and explanatory discussion does occur in person.  Nothing will replace a face to face consult and examination.  In fact, when I do a free email consult, I always emphasize that everything still has to be confirmed when I meet the patient on the day prior to surgery.

Good luck!

Dr Jacobs

[DrBermant]

I have a relatively mild case of gynecomastia.  However, I'm very fit, so my puffy nipples definitely stand out.  I am considering getting surgery to have the glands removed, but I am worried about noticeable scarring following surgery.  I'm trying to gauge which would be more embarrasing: having puffy nipples, or having scars that make people aware that I have had cosmetic surgery to remove the puffy nipples. 

I am also having a hard time finding pictures of VERY close up pics of scars from the surgery.  Can anyone give me some more information on the scarring and how noticeable it is generally.  Also, if the scar doesn't subside within a say a year, is it most likely going to look that it does forever? 

Last question - I'm considering have surgery with a Dr. who is about 5 hours from my home.  He offers a $125 consultation that can be done by email for patients who are from out of town.  Is it really important to have the consultation in person, or is it ok to have it over email by providing pictures and information to the surgeon? 

I hope you guys are able to provide me with some answers.  I am highly contemplating surgery, but I don't want to go through with it, if I will have noticeable scars the rest of my life.  Thanks...

Close up views of the scars and how the tissues move all factor into a good result. Check this patient's experience here on this forum:

https://www.gynecomastia.org/smf/index.php?topic=21783.msg147436;topicseen#msg147436

Here is another post with the same question and which has resources to answers:

https://www.gynecomastia.org/smf/index.php?topic=20310.msg138801;topicseen#msg138801

And here is another example of close up pictures and videos of a bad scar from another surgeon who put the scar inside the areola, that I had to move to the edge of the areola during the revision surgery. Now that patient did complain the the original doctor about the scars and the residual gland behind.

https://www.gynecomastia.org/smf/index.php?topic=20199.msg138176;topicseen#msg138176

All surgery involves scars, they are a compromise for doing the surgery. The trick is to minimize them as much as possible. I caution each of my patients that there will be scars. My goal is to have each patient tell me that their experiences were as good as or better than what they found on my website.

I do offer a preliminary remote discussion. This does involve emails, but the email is not the consultation. In my opinion, emails alone are not sufficient for me to feel comfortable to book even a tentative surgery. I prefer a more dynamic approach and exchange of information and questions which we do by telephone. The emails are the way to exchange the initial information that is then explored by phone. With my standard pictures and information, this telephone discussion helps my patients schedule tentative surgery that is done after the confirmatory in office consultation done the day before surgery.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737