Puffy nipples... but no hard disk?

[ladiesman69]

How is it that I have puffy nipples yet lack the typical hard disk underneath the areola? Would this indicate that my gyno is caused from an isolated excess of fat (which remains, despite low BF)? Or could there still be a gland issue?

[ladiesman69]

I just wanted to add too that I have some hormonal imbalances, so because I lack the hard disk is there any chance that resolving these issues could also resolve the gyno?

[Dr. Elliot Jacobs]

There are a lot of misconceptions about gynecomastia.  One of them is that one can feel firm, hard or different tissue under the areola.  Actually, it is very difficult to feel for breast tissue -- sometimes it feels as soft as fat.  And sometimes fat feels very firm -- so it can be confusing.  Even my surgically trained hands cannot totally differentiate the tissues sometimes.

What you have to understand is that excess fat alone never causes puffy nipples -- it is always due to excess breast tissue under the areolar area.  So if you have puffy nipples, you can diagnose gynecomastia just by looking at it.

Dr Jacobs

[tpuk]

i never had hard tissue or anything - but still had moderate gyno

[ladiesman69]

There are a lot of misconceptions about gynecomastia.  One of them is that one can feel firm, hard or different tissue under the areola.  Actually, it is very difficult to feel for breast tissue -- sometimes it feels as soft as fat.  And sometimes fat feels very firm -- so it can be confusing.  Even my surgically trained hands cannot totally differentiate the tissues sometimes.

What you have to understand is that excess fat alone never causes puffy nipples -- it is always due to excess breast tissue under the areolar area.  So if you have puffy nipples, you can diagnose gynecomastia just by looking at it.

Dr Jacobs

Ok, thank you very much for your response!

On this topic then of breast tissue, what happens if too much is taken away and there are issues such as a slight indentation of the nipple, folding of the nipple in certain positions and so on? How can this be fixed? Is it a case of transfering tissue and fat from other parts of the body?

[Dr. Elliot Jacobs]

"what happens if too much is taken away and there are issues such as a slight indentation of the nipple, folding of the nipple in certain positions and so on?"

What you are describing is contour deformities and/or crater deformities.  While there is no absolute certainty about avoiding these problems, your choice of a very experienced gyne surgeon will go a long way to making sure this doesn't happen.  It is my very firm opinion that craters and other contour deformities can and should be recognized at the time of surgery and corrective action taken then and there.  Craters do not cure themselves over time -- they would then require additional revision surgery, which is more difficult and less predictable.  Better to recognize and deal with it at the initial operation.

Dr Jacobs

[ladiesman69]

Thank you again for the quick response. It's comforting to know that a good surgeon is my best best to avoid this. However, as we know we don't live in a perfect world. In the event that I did get crater deformities, how is this rectified? Is it a difficult thing to do? And what kind of results have you seen from these kinds of revision operations?

[Dr. Elliot Jacobs]

As they say in football, "The best offense is a good defense."  In essence, it is best to take all precautions NOT to get a crater in the first place.  That starts with choosing your surgeon very carefully.  And then your surgeon should be aware of this potential problem and take steps to rectify it at the time of surgery if it should occur.

All that said, if you do end up with a crater, one can consider revision surgery, which is always playing "catch-up."  The usual treatments are either fat flaps (preferred, if possible) or fat grafting.

If you wish to read further, look up treatment of crater deformities on my new revision gynecomastia surgery website (captioned below).

Dr Jacobs