Author Topic: Advice From A Doctor  (Read 5081 times)

Offline jimmy1234

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I was wondering if maybe one the doctors who frequent this board can help me out with my situation.
First of all, I have suffered with gyno my whole life and although i was told it was a mild case it has hindered my life incredibly as many people on this board can relate to. I had very puffy nipples that poked through my shirt. 10 years ago I had surgery that was covered by the BC government and when this was done I was told they would remove the gland by scalpel and then the nipple would settle in and would not be noticable. This did not work. Then about 3 years ago I went to the plastic surgeon and for the cost of 5000$ he performed lipo and this procedure although more succesful than the first still did not result in my nipples settling in. He performed some revision surgery about 6 months for another 500$ after this and I was told that it would settle in nicely which did occur on one side more than the other but I still could not wear t shirtsor tight shirts without people staring. I went back to the same plastic surgeon this Friday and he said for another 500$ he could remove the gland in his office and cut the areola from the inside and this will result in my nipples being flat to my chest.This is what I was told on the last occassion. I don't want to keep on having revision surgery year after year with the result of never being pleased. I have consulted my endo and he has done all the necessary tests. I don't know how much claearer I can be with this doctor about what I want. i told him that it was more important for me that my nipples don't poke through my shirt than having a ntural look. any advice?

DrBermant

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I was wondering if maybe one the doctors who frequent this board can help me out with my situation.
First of all, I have suffered with gyno my whole life and although i was told it was a mild case it has hindered my life incredibly as many people on this board can relate to. I had very puffy nipples that poked through my shirt. 10 years ago I had surgery that was covered by the BC government and when this was done I was told they would remove the gland by scalpel and then the nipple would settle in and would not be noticable. This did not work. Then about 3 years ago I went to the plastic surgeon and for the cost of 5000$ he performed lipo and this procedure although more succesful than the first still did not result in my nipples settling in. He performed some revision surgery about 6 months for another 500$ after this and I was told that it would settle in nicely which did occur on one side more than the other but I still could not wear t shirtsor tight shirts without people staring. I went back to the same plastic surgeon this Friday and he said for another 500$ he could remove the gland in his office and cut the areola from the inside and this will result in my nipples being flat to my chest.This is what I was told on the last occassion. I don't want to keep on having revision surgery year after year with the result of never being pleased. I have consulted my endo and he has done all the necessary tests. I don't know how much claearer I can be with this doctor about what I want. i told him that it was more important for me that my nipples don't poke through my shirt than having a ntural look. any advice?

It really depends on the nature of the problem, what was done, and realistic expectations.


"Puffy Nipples" is a common public term for gynecomastia. Such projection in its many forms tends to poke through clothing.

The problem is the the term puffy nipples is a phrase that mean so many different things to so many different people.  Words just do not convey the actual problem very well - images do a little better, but still are not the same as an actual in office evaluation with your doctor.  This Gynecomastia Picture Gallery of Puffy Nipples begins to show some of the various problems patients have called "puffy."

Putting up pictures (using standard views for considering problems for revision surgery) and putting up photos of the original problem and at each stage is one way to discuss what the problem was before surgery and what has happened.   Options depend on what is really going on.

Let us try to look what I mean by the problem of the words only descriptions.  "Large nips", "puffy nipples," "puffed nipples,"  and "puffy nips" are a common terms many give to a problem that extends to the region about the areola.   The nipple is actually the central raised structure inside the pigmented areola.

"Puffed nipples" can be a problem for some that involves long nipples above the areola where nipple reduction alone helps.

"Puffy Nipps" can be a problem behind the areola that can take many forms.  The deformity is usually a varying combination of fat and gland.  The gland can be firm or soft, spread through fat, or be a condensed mass.  There is a thin muscle under the areola skin that can flatten tissue when stimulated. Unfortunately it is impractical to keep stimulating these muscles.

In many of these patients with "puffy nipples," there was no firm tissue under the areola, just fat and soft gland.  Here is one example of puffy nipples in a muscular male.  Here is another example of   puffed nipples.  Here is another patient with puffy nipple gynecomastia.

"Puffy Nipples" can also be a combination of gynecomastia and big nipples.

Let's check the Anatomy of Puffy Nipples. In the problem of revision surgery, the deforming tissues can be skin (long nipple), residual gland, scar tissue, or a combination.

Here is one example how Revision Surgery Can Help Residual Puffy Nipples. Here is another example of Revision Gynecomastia Surgery.

Revision Gynecomastia Surgery can help with such contour deformities but is an art form.  I perform many revision surgeries, but rarely on one of my own patients.  Primary surgery should be able to manage most such problems.  I prefer my Dynamic Technique that adapts to the problem found during surgery to minimize such issues as residual deformity after surgery.

However, there sometimes is an issue of realistic expectations. There are limitations to what any surgeon can offer.

Such issues are best explored during a consultation with full details of the original problem, what has been done to date, and the nature of the current problem.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia

Offline jimmy1234

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Yaeh some of those pictures resemble what my nipples look like and perhaps the fat flab surgery is what is necessary. I am 6 foot 1 and weigh 200 pounds. run about 6 miles each day as well. so i am athletic. Maybe give it this one more shot. already have spent 5500$ so i guess what the heck is another 500

Offline jimmy1234

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Bythe way I am trying to post photos but am a little computer illiterate. Cansomeone let me know how to do it. Thanks


Offline Dr. Elliot Jacobs

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It is possible that you may have just a build-up of scar tissue.  And each time your surgeon operates and removes scar tissue, you heal with -- you guessed it -- more scar tissue.

I think you should have a heart to heart talk with your surgeon.  If, after your prior revisions, your nipples and areolas were flat, and then they "puffed" out again within weeks to months, and if the surgeon is sure that he removed all appropriate tissue (and left some tissue to prevent cratering), then perhaps the problem is just scar tissue.  And scar tissue can be treated with steroid injections -- not more surgery.

Speak to him at length about these concerns.

Dr Jacobs
Dr. Jacobs 
Certified: American Board of Plastic Surgery
Fellow: American College of Surgeons
Practice sub-specialty in Gynecomastia Surgery
4800 North Federal Highway
Boca Raton, Florida 33431
561  367 9101
Email:  dr.j@elliotjacobsmd.com
Website:  http://www.gynecomastiasurgery.com
Website:  http://www.gynecomastianewyork.c

Offline jimmy1234

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Thanks. I went in for further consultation and he said he could remove some more tissue however he said he was concerned with catering. I will call his office and discuss this with him before I do more. I did have my endo look at it though and he did say in terms of scarring the initial surgeon did a good job. So iam just assuming that the statemenyt included scar tissue.


 

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