Dr. Jacobs Website Question

[MSJ108]

Dr. Jacobs,

 I found this on your website...


18. What can be done for "puffy nipples?"
"Puffy nipples" is a common complaint and one for which treatment can be difficult. It refers to a "dome-like" appearance of the areola. As you know, your nipples will change and tighten in response to temperature changes or physical/emotional stimulation. This ability to change has to do with tiny muscle cells within the areola (pigmented skin). No surgery, injection, pill, cream, etc can substantially alter this normal bodily physiologic change. What must be evaluated is whether you have any firm breast tissue beneath the areola which is causing projection of the areolas and how much is possible to be removed. Surgery to remove this breast tissue must be done carefully, for if overdone, it can result in a depression (like a saucer) which is difficult to correct.

Couldn't one not have any firm breast tissue beneath/behind the areola, but still have "puffy nipples" from slight fat build up or a combo of fat and gland mix that is not firm or hard?

I do not have any firm gland behind the nipple areola. However, my nipples got puffy (when not cold or nipples not stimulated) about 5 years back. I looked at old picture and in the past my nipples were much flatter. Now my nipples are puffy when not cold, semi-puffy at some times, and hard and very small when very cold or nipples are stimulated. It is very embarrassing. One doctor told me I may need a lift but I find that hard to believe when I look at others gyne pictures. Thanks Doc.

[MSJ108]

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[MSJ108]

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[Grandpa Bambu]

Calling Dr. Jacobs.... Calling Dr. Jacobs....

GB

[MSJ108]

Calling Dr. Jacobs.... Calling Dr. Jacobs....

GB

Yup Yup!!!

[Grandpa Bambu]

Calling Dr. Jacobs.... Calling Dr. Jacobs....

GB

Yup Yup!!!

I sent Dr. Jacobs the link to this thread... but... no response yet....    Hmmmm... 

GB

[MSJ108]

He is really good. I am sure he will get to it eventually. Thanks for your help Grandpa

[Dr. Elliot Jacobs]

It really doesn't make a difference whether the tissue beneath the areola is firm or hard -- what truly matters is the amount of tissue and the contour!  The tissue buildup under the areola can be breast tissue or breast tissue with fat -- but definitely not just fat alone.  There is no physiologic reason why fat would simply grow directly under the areola and nowhere else on the chest!

In a normal male, when the areola is relaxed (ie not stimulated by cold or emotion), it should lie flat and continuous with the surrounding skin.  If it bulges (ie, it is puffy) then there is some extra tissue (it doesn't really matter precisely what type of tissue it is) underneath which should be surgically removed. Surgery must be done with care to prevent a depression of the areola.

The fact that it puffs out on occasion and is flat on occasion is due to the tightening effect of those tiny muscles within the areolar skin itself.  When they tighten, the skin constricts and tightens and in essence pushes or tucks in the excess tissue underneath -- but it is still there. It is as if you pushed the tissue in with a finger -- the tissue is still there.

Therefore, the best treatment for puffy nipples will be surgery.

Elliot Jacobs, MD, FACS

[MSJ108]

Dr J for President!

Thanks Doc!!

[Grandpa Bambu]

Thanks Doc!

GB