A few questions - compression vests and scarring.

[Teenaged]

I am looking at getting surgery soon.  I have several questions. 

The surgery won't be until May probably and I was wondering how noticeable the compression vests are in only a  t-shirt?  Is the vest kind of like under armor or is it more noticeable?  Are there any good ways to conceal the vest besides having to wear a sweatshirt in the middle of summer?  How many weeks do people have to wear the vest for?

Also, my gynecomastia is basically only puffy nipples.  I am very fit, and have no extra fat on my chest.  I have a hard lump under each nipple which causes my nipples to stick out and look puffy.  Will excision be the way the doctor fixes this during surgery?

How noticeable are scars normally from excisions near the nipple?  Is puffy nipple surgery easier for a doctor to perform?  Is their less risk of my chest looking uneven or messed up afterwords since it is only 2 small glands that would need to be removed? 

Thanks for any and all information! 

[Dr. Elliot Jacobs]

The surgery won't be until May probably and I was wondering how noticeable the compression vests are in only a  t-shirt?  Is the vest kind of like under armor or is it more noticeable?  Are there any good ways to conceal the vest besides having to wear a sweatshirt in the middle of summer?  How many weeks do people have to wear the vest for?

I recommend to my patients that they wear the compression vest for a minimum of four weeks after surgery.  It is a thin garment, made of stretchable elastic material.  It might be visible under a tight T-shirt -- but you could hide it by wearing a regular shirt.  In any event, you may have to make some compromises if you plan to have your operation in May -- but in the end it will be well worth it.

Also, my gynecomastia is basically only puffy nipples.  I am very fit, and have no extra fat on my chest.  I have a hard lump under each nipple which causes my nipples to stick out and look puffy.  Will excision be the way the doctor fixes this during surgery?

In my experience, usually puffy nipples will require an excision in order to flatten them appropriately.  I usually include some liposuction in order to allow the skin to re-distribute.

How noticeable are scars normally from excisions near the nipple?  Is puffy nipple surgery easier for a doctor to perform?  Is their less risk of my chest looking uneven or messed up afterwords since it is only 2 small glands that would need to be removed?

The peri-areolar scars tend to heal well -- sometimes they are very difficult to see.  However, there are numerous factors in play here.  The skill of the surgeon and the innate healing ability of the patient both play important roles. 

No, puffy nipple surgery requires the same skill and artistry as any other type of gyne surgery -- there are no "minor" gyne operations.

Choose your surgeon carefully -- do your research.

Dr Jacobs

[DrBermant]

I am looking at getting surgery soon.  I have several questions. 

The surgery won't be until May probably and I was wondering how noticeable the compression vests are in only a  t-shirt?  Is the vest kind of like under armor or is it more noticeable?  Are there any good ways to conceal the vest besides having to wear a sweatshirt in the middle of summer?  How many weeks do people have to wear the vest for?

I use two different types of after surgery compression garments for my male chest sculpture. I have found the underarmour garments ineffective for my needs in order to achieve results as seen on my website. This first stage garment controls bruising, bleeding, swelling and comfort. Check out this thread to learn more about garments and find resources to see what typical bruising and swelling looks like after surgery when using this garment.

https://www.gynecomastia.org/smf/index.php?topic=22138.msg149143#msg149143

My patients tell me that a normal T shirt hides the garment quite well. It will show through fine French silk shirt. Many years ago I went to this manufacturer and had them change the design to make this first stage garment much less noticeable. The second stage garment looks like a work out shirt. Scars that evolve under pressure do so much better than scars without pressure. Now we are talking about not just surface scars, but scars throughout the sculpture: how tissues move. That is why I demonstrate my results with flexing photos and videos after surgery. When will the scars be soft? Each patient is different as is each wound. You probably have had several wounds in your life. How long did they take for the wound to be soft?  The same thing goes for timing of the first stage garment. This garment is for the protection. Stop wearing the garment too soon and the tissue is unprotected. If too early activity will result in swelling. I prefer to maximize my patients' healing and recovery. When peak swelling occurs during surgery and does not recur, the patient is protecting the tissues optimally and will heal faster.

Also, my gynecomastia is basically only puffy nipples.  I am very fit, and have no extra fat on my chest.  I have a hard lump under each nipple which causes my nipples to stick out and look puffy.  Will excision be the way the doctor fixes this during surgery?

How noticeable are scars normally from excisions near the nipple?  Is puffy nipple surgery easier for a doctor to perform?  Is their less risk of my chest looking uneven or messed up afterwords since it is only 2 small glands that would need to be removed? 

Thanks for any and all information! 

Puffy nipple gynecomastia is its own art form and quite demanding surgery. It is its own art form which is why I have a section of my website dedicated to this deformity. Here is a post I did with many resources about puffy nipples:

https://www.gynecomastia.org/smf/index.php?topic=19149.msg131886;topicseen#msg131886

Make sure the doctor you are considering demonstrates many examples of this variation of male breast reduction. For the scars, you need to look not just at the surface, but the entire sculpture, how the tissues move.

What is even more complex is dealing with Puffy Nipple Complication after Surgery. That is something best avoided by careful investigation of a doctor's skills and outcomes. Check out this thread on that topic:

https://www.gynecomastia.org/smf/index.php?topic=21332.msg144631;topicseen#msg144631

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