Angry and disappointed 2 years after gland removal surgery

[fedupbro]

2 years ago i had the glands removed and now it looks exactly like it did before. My nipples still puff out, badly. I'm 6'1, 180lbs, which is the same weight i was when i had the surgery.

Before the surgery, i was skeptical about how removing the glands from underneath would somehow result in the nipples shrinking to a flat state. For a month or 2 after wards, they looked flatter, but they slowly came back out to be exactly how they were before. I wore a compression garment as my surgeon had instructed me to.

The area underneath the nipple feels empty, but still it just puffs out. I believe that surgeons know this will often be the case but don't tell their patients about it.

I'm considering actually nipple reduction surgery but can't seem to find much information on it and its' costs

not happy man

[Dr. Elliot Jacobs]

Don't give up and be angry.

Your first step should be a re-visit to your surgeon to show him the results of the surgery and ask if he can do something to remedy the situation.

The second step should be a consultation with an experienced gyne surgeon for a second opinion.

You should not have to live with the results that you describe.

Dr Jacobs

[DrBermant]

2 years ago i had the glands removed and now it looks exactly like it did before. My nipples still puff out, badly. I'm 6'1, 180lbs, which is the same weight i was when i had the surgery.

Before the surgery, i was skeptical about how removing the glands from underneath would somehow result in the nipples shrinking to a flat state. For a month or 2 after wards, they looked flatter, but they slowly came back out to be exactly how they were before. I wore a compression garment as my surgeon had instructed me to.

The area underneath the nipple feels empty, but still it just puffs out. I believe that surgeons know this will often be the case but don't tell their patients about it.

I'm considering actually nipple reduction surgery but can't seem to find much information on it and its' costs

not happy man

I have seen so many patients unhappy asking for my help after surgery done elsewhere complaining of similar issues I named the condition

Puffy Nipple Complication After Gynecomastia Surgery

 and built resources explaining what I was finding in the operating room revising these patients and demonstrated the condition with before and after pictures with several examples.

For the subset of patients who had gland removal surgery as the only or a component of their surgery done elsewhere, the most common issue was that the first surgeon left a shelving edge of gland under the areola to "support" the nipple. This firm tissue does not compress like fat and as the areola muscle relaxes, the deformity shows. The gland can adhere to more than just the central anatomic nipple. This adherence also can keep the areola skin from shrinking with surgery.

That is why it is so critical to see what a doctor's techniques truly offers checking a complete set of before and after pictures like I have developed to demonstrate such issues. Look for Standard After Gynecomastia Pictures to see what this set of documentation has evolved into.

Just how much the areola skin shrinks really does depend on the original problem, what was done, the skill of the doctor, the nature of the individual's tissue, after surgery care, scar care, and many other factors. Here is one such limited demonstration here on this site:

Large Gland Removed Through Tiny Edge Areola Incision.

Puffy Nipples Before Surgery

Calipers Set to Before Surgery Dimensions

Calipers Set to Before Surgery Dimensions

The after surgery images are only 7 days after surgery. The steristrips are there for both wound support and areola splinting.

I am sorry that the patient holding the calipers for the pictures could not maintain the edge of the calipers at the edge of the areola. When I am demonstrating the effect, I am holding the instrument myself. But it is hard to do the pictures and hold the calipers at the same time.

These are not exaggerations nor manipulation of pictures, just an amazing deflation of nipple areola gland deformity achieved by targeting the gland first.

The vertical deflation measurement or pictures is even more dramatic. For that measurement, I have the patients look down at their chest with the caliper set in place. Here is an example from the prior post patient's projection change:

Calipers Set to Before Surgery Dimensions


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

For years have been documenting this issue by measuring the nipple areola complex before and after surgery. I take measurements of the

• long axis
• short axis
• angle the axis varies from the horizonatal
• height projection

I perform this measurement with calipers.

Just like Dr. Jacobs mentions I see an areola shrinkage with surgery. Just how much the areola shrinks, I think is technique dependent. By targeting gland first in every case where there is a gland contour component, the differences can be really radical. The tissues of the nipple areola complex can attach to the gland just at the anatomic nipple or more commonly through a diffuse attachment to the edge of the areola and beyond. When this gland attachment remains behind, the nipple areola can be forced to the larger remaining gland size. The remaining gland can also be one of the causes of the term I coined Residual Puffy Nipple Deformity, where the shape of the areola maintains the gland shape and size.

The changes I was seeing were so dramatic, that I started using the calipers on the patients' chest in front of a mirror to show the differences. This became a component of my program for the emotional healing component for each patient who permits me to take off the dressing in my office or who returns for a long term followup.

Large Gland Removed through tiny 1.6cm incision.

Puffy Nipples Before Surgery

Calipers Set to Before Surgery Dimensions

Calipers Set to Before Surgery Dimensions

Notice the radical change in size and shape of areola. In some dimensions we have been recording a 70 percent decrease in size of some of the dimensions. There is also a concentration of pigment color. The same number of color cells in a smaller results in a darker areola.

I prefer to start the emotional healing component as quickly as possible. What becomes fun is seeing the expressions on the faces of my patients as they look at the mirror seeing what changes have happened. This has gone way beyond the documentation of a technique, it has become part of the healing.

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

There are 2 patient sets of images demonstrating the caliper measurements I perform on each of my patients to document the amazing amount of skin reduction, projection decrease, and help with emotional healing of my patients. The issue is that tuberous breasts come in different degrees and you need to see just what a doctor offers. Unfortunately, the images I am referring to on gyn.org are not my normal complete patient presentation of what results look like such as for the tuberous breast deformity you are asking about. The post was about the areola reduction seen with this technique. They were not posted for a presentation of tuberous breast surgery evaluation. They were a demonstration of the degree of skin shrinkage I see by targeting gland first.

To understand just what a doctor's results are like you need to see at least a standard set of images with flexing, arms up overhead, and all angles. You are looking to see if that doctor needs to remove a band of skin to achieve the results. That skin reduction scar is a significant compromise, so close up pictures of what the scar looks like are important. This is a loose skin issue and videos are even more critical in evaluating the results.

Here's my condition. https://www.gynecomastia.org/smf/index.php?topic=16389.msg114150#msg114150 I'm getting so desperate. This condition is killing me. My whole life is Waiting in limbo until I get this surgery. All I want to do is join the military and serve this country but my chest doesn't allow that. My credit got denied for a loan. My mother passed away and I was left with alot of debt including a mortage and other expenses. Typical adult problems. I wear a compression vest everyday n have been for the past 4years and I'm just sick of it. Haven't been in a pool or the ocean since a kid and I live 4-5min from the beach. Just want to cry sometimes

In the thread you quote,

https://www.gynecomastia.org/smf/index.php?topic=16389.msg114150#msg114150

you can see resources to full examples of tuberous breast sculpture that I gave you 1/3/2009.  I see you have adopted the contouring garments also demonstrated in that thread. They can be a help, but do not remove the deformity. My patients who cannot afford surgery, but want to get into the water use variations of a wet suite to permit enjoying water activities. Neither the vest nor the wet suite will work on the beach. For that they use sun protective garments which are baggy.

I have had patients come to see me while in the military with such deformities, so it did not prevent them from serving. Yes, it was embarrassing, but the limiting factor is your personal stress not their requirements. When problems do not have easy fixes, passing on our patients' prior creativity is what we offer. It can be quite frustrating living with such contour issues. Have you tried these other options that my patients have used with success while they waited to have surgery?

To compliment the caliper pictures in my post above here are only two views of the many really required to evaluate the condition result. The first is arms on hips muscles flexing which helps better understand if there are wrinkles in the skin sculpture when flexing the muscles. The second is the oblique. The full set is seen in the link discussed above. However this example for the calipers is closer to your actual deformity than those on my site.

Puffy Nipples Tuberous Breasts Before Surgery

15 Months After Surgery

Puffy Nipples Tuberous Breasts Before Surgery

15 Months After Surgery

No skin reduction was done. The videos before and after surgery for that patient are even more demonstrative of the deformity and sculpture.

Having surgery without checking just what that doctor offers is a major risk. If you did investigate but your results vary, that can be an ethical issue. My goal in putting up so many examples on my site with as complete documentation of the problem and results is to have my patients tell me that their results were close to or better than what they saw there. Unfortunately, I have also heard patients coming to me for revision tell me that they did check my results, but then went to a closer doctor for convenience assuming that all doctors can get the same results. Unfortunately, that is not the case, this is an artistic skill that each surgeon should be able to demonstrate what their results are like.

Why not put up a standard set of after surgery pictures to let others better understand your concerns?

Hope this helps,

Michael Bermant, M.D.

[fedupbro]

I appreciate the time you took to reply. However, i don't understand this residual gland idea. If this is a condition you've identified and named, perhaps you could make a basic diagram of how this works. I 'd love to know. A small piece causing my whole nipple to still puff out is hard for my brain to grasp. I could also take this diagram to my surgeon when i go back and ask him about this idea.

Also, i believe asking a surgeon to demonstrate what their results look like beforehand is probably just going to get you a look at a best case scenario which they've happily photographed, followed by a "results may vary" type disclaimer. Also, before i had surgery, i could make myself look like i didn't have gyno by pinching my nipples or just making them cold somehow. So i would be skeptical of any photos i saw if they were taken by someone with a financial interest in encouraging surgery.

[DrBermant]

I appreciate the time you took to reply. However, i don't understand this residual gland idea. If this is a condition you've identified and named, perhaps you could make a basic diagram of how this works. I 'd love to know. A small piece causing my whole nipple to still puff out is hard for my brain to grasp. I could also take this diagram to my surgeon when i go back and ask him about this idea.financial interest in encouraging surgery.

I have already done that and it is on my website. The drawing is dynamic permitting interaction during the learning process. Sorry, the new owner no longer permits links. Building resources like that are only part of the learning process. Years ago I analyzed what did it take to get my patients the education to become partners in their sculpture. In my opinion, the educated patient plays a key roll in optimizing the best from surgery. Since it was so easy for me, I decided to put it up on the internet so patients who wanted to learn could do so in the comfort of their homes. Beyond that for my patients, we then continue the education during consultations or my Preliminary Remote Discussion.

Also, i believe asking a surgeon to demonstrate what their results look like beforehand is probably just going to get you a look at a best case scenario which they've happily photographed, followed by a "results may vary" type disclaimer. Also, before i had surgery, i could make myself look like i didn't have gyno by pinching my nipples or just making them cold somehow. So i would be skeptical of any photos i saw if they were taken by someone with a financial interest in encouraging surgery.

Photographic manipulation is an incredibly valuable tool for Rhinoplasty surgery and I use a variation for some of my reduction otoplasty ear surgery. I have lectured and taught the subject to my peers at national meetings. I have investigated and proven it does not have value in surgery of the male chest. Yes, I can change the images as part of a teaching process, that is easy. The problem is having results that then come close to those pictures. Just does not happen, it is not a good tool in my opinion for the education of patients about what can be done for this sculpture.

In my years of trying to learn how to teach the public, patients, (and for that matter surgeons) about male chest contouring I have found that by standardizing the photos and videos, I was able to come up with the best tools. Setting up a system to make before and after surgery images consistent is important.

Pictures doctor's use to teach patients are supposed to be typical for result that doctor achieves. That is part of the ethics standards for the United States Plastic Surgery Societies. They have a hard time policing what doctors show in their offices but what is up on their websites can be more carefully looked at. It is part of the process of even getting into the society.  Over the years I have discussed this issue with reviewers from the society who were tasked with evaluating such information. I was also instrumental in having the bylaws of the society changed to protect the public from such postings. The problem is in the policing of such information.

For my own practice, I maintain strict standards for such documentation. I keep the room temperature warm for exam, photos, and even surgery (for patient comfort). Lighting, background, and camera settings are standardized and matched for the progression of healing documentation. Over time this can be a challenge. When I started, there were no digital camera and videos were way outside the range of affordability for a private practicing surgeon. Over the nearly 4 decades I have been doing this, many of the cameras I used were retired for newer technology. Matching that documentation standardization can be quite a challenge. So, for even the compulsive, there can be limitations.

My goal for my patients is to have them be able to tell me that their experiences were close to or better than what they found on the internet. If you listen to the video examples, that became part of the structured discussion asked about each patients' experiences and documentation. Perhaps some day I will publish more of those videos.

Hope this helps,

Michael Bermant, M.D.