OMG IT'S BACK. 1 Month Post Op - 1 Puffy Nipple Returned

[jamesbond007]

Hi all,

I am 1 month post op.

Had excision surgery.

After the surgery, my nipples were as flat as a pancake. I loved it.

Starting the 3rd week, my left side started to puff up.. and up.. now 1 month post op, it is puffy again. (Not as bad but still puffy).

My other side is perfectly fine!

Why has it started to puff back out when after the surgery it was flat?

Should I put my compression vest back on? Should I massage the area to make it go away? Please help!

[Dr. Elliot Jacobs]

If it was originally flat after surgery, then you MAY have the beginning of scar tissue under the areola.  Best to return to your surgeon for advice on how to manage this.

The other alternative is that if the surgeon only did excision without undermining (ie loosening) the surrounding skin, then the puffy skin has absolutely nowhere to go except to puff up again.  You should discuss this also with your surgeon.

Good luck!

Dr Jacobs

[headheldhigh01]

dr jacobs, do appreciate the expert opinions you take the time to offer here. 

to clarify that last thought, by surrounding, do you mean at the periphery, or above the area of the excision itself?  if above it, i would have, in my ignorance, thought that loosening it would have freed it to expand rather than hold close, but maybe i'm not picturing that right.  thanks. 

[Dr. Elliot Jacobs]

Please allow me to clarify.

If one has a puffy nipple and has surgery merely to remove the underlying gland, then the expanded areolar skin will predictably "bunch up" post op and scar tissue frequently will replace the removed gland.  Net effect is that the puffy nipples seemingly remain.

I have found that a more extensive operation is required.  Once the excess sub-areolar tissue is removed, then the surrounding skin, in all directions, should be undermined.  This will provide a place for all the skin -- and the areola -- to settle down.  Mother Nature usually allows the areolar diameter to shrink after appropriate surgery.

Hope this has helped.

Dr Jacobs

[ladiesman69]

Please allow me to clarify.

If one has a puffy nipple and has surgery merely to remove the underlying gland, then the expanded areolar skin will predictably "bunch up" post op and scar tissue frequently will replace the removed gland.  Net effect is that the puffy nipples seemingly remain.

I have found that a more extensive operation is required.  Once the excess sub-areolar tissue is removed, then the surrounding skin, in all directions, should be undermined.  This will provide a place for all the skin -- and the areola -- to settle down.  Mother Nature usually allows the areolar diameter to shrink after appropriate surgery.

Hope this has helped.

Dr Jacobs

In a similar case to OP. I've had the operation and whilst I feel hard scar tissue on the right side the left seems relatively free of it all. Despite this both are puffy. Perhaps just as puffy as pre-op.

Just like before the operation I feel nothing under the gland and all soreness of scar tissue and the likes isn't there anymore.

If it was scar tissue causing it to be puffy wouldn't I be able to feel it as a hard lump around the area (like I can on the right side)?

[jinr0h]

Please allow me to clarify.

If one has a puffy nipple and has surgery merely to remove the underlying gland, then the expanded areolar skin will predictably "bunch up" post op and scar tissue frequently will replace the removed gland.  Net effect is that the puffy nipples seemingly remain.

I have found that a more extensive operation is required.  Once the excess sub-areolar tissue is removed, then the surrounding skin, in all directions, should be undermined.  This will provide a place for all the skin -- and the areola -- to settle down.  Mother Nature usually allows the areolar diameter to shrink after appropriate surgery.

Hope this has helped.

Dr Jacobs

In a similar case to OP. I've had the operation and whilst I feel hard scar tissue on the right side the left seems relatively free of it all. Despite this both are puffy. Perhaps just as puffy as pre-op.

Just like before the operation I feel nothing under the gland and all soreness of scar tissue and the likes isn't there anymore.

If it was scar tissue causing it to be puffy wouldn't I be able to feel it as a hard lump around the area (like I can on the right side)?

I think it has to do with swelling. I took off my garment like 3 days post surgery and nipples were puffy state.. Now im 3 weeks later and its a lot flatter, i feel theres changes in my chest everyday.. i went from super paranoid/depressed to content with my chest. I told myself not to stress over it cause i had read many post about post surgery puffy nipps etc, yet i was convinced i needed a revision surgery 2 weeks post op .. lol . my advice is give it a rest and try to get your mind off the chest for a bit ..worst case scenario you work toward a revision.. it is what it is
good luck

[ladiesman69]

Please allow me to clarify.

If one has a puffy nipple and has surgery merely to remove the underlying gland, then the expanded areolar skin will predictably "bunch up" post op and scar tissue frequently will replace the removed gland.  Net effect is that the puffy nipples seemingly remain.

I have found that a more extensive operation is required.  Once the excess sub-areolar tissue is removed, then the surrounding skin, in all directions, should be undermined.  This will provide a place for all the skin -- and the areola -- to settle down.  Mother Nature usually allows the areolar diameter to shrink after appropriate surgery.

Hope this has helped.

Dr Jacobs

In a similar case to OP. I've had the operation and whilst I feel hard scar tissue on the right side the left seems relatively free of it all. Despite this both are puffy. Perhaps just as puffy as pre-op.

Just like before the operation I feel nothing under the gland and all soreness of scar tissue and the likes isn't there anymore.

If it was scar tissue causing it to be puffy wouldn't I be able to feel it as a hard lump around the area (like I can on the right side)?

I think it has to do with swelling. I took off my garment like 3 days post surgery and nipples were puffy state.. Now im 3 weeks later and its a lot flatter, i feel theres changes in my chest everyday.. i went from super paranoid/depressed to content with my chest. I told myself not to stress over it cause i had read many post about post surgery puffy nipps etc, yet i was convinced i needed a revision surgery 2 weeks post op .. lol . my advice is give it a rest and try to get your mind off the chest for a bit ..worst case scenario you work toward a revision.. it is what it is
good luck

In my case they were perfect and flat post-op. It's now that I'm 3-4 months post-op they've become more puffy and scar tissue become more noticeable. Whilst I can't feel anything on the left side perhaps there is some there too that is causing puffiness?

I'll give it 6 months before I take any action. Hopefully it is just scar tissue

[Dr. Elliot Jacobs]

  they were perfect and flat post-op. It's now that I'm 3-4 months post-op they've become more puffy and scar tissue become more noticeable.

This scenario sounds like you may have developed some scar tissue.  If so, then oftentimes an injection of cortisone can be helpful.  Suggest you consult with your surgeon.

Dr Jacobs

[ladiesman69]

  they were perfect and flat post-op. It's now that I'm 3-4 months post-op they've become more puffy and scar tissue become more noticeable.

This scenario sounds like you may have developed some scar tissue.  If so, then oftentimes an injection of cortisone can be helpful.  Suggest you consult with your surgeon.

Dr Jacobs

Why can't I feel scar tissue around one side though? That is what concerns me. I would imagine if it were scar tissue I'd feel a hard lump or something

[Dr. Elliot Jacobs]

Simple -- scar tissue isn't always hard!!!!

Dr Jacobs

[ladiesman69]

Simple -- scar tissue isn't always hard!!!!

Dr Jacobs

Very re-assuring! I'll stop freaking out, keep massaging, and see how things are at the 6-10 month mark

Thank you Dr Jacobs!