Almost a month after surgery :( Not pleased at all.. Still puffy?! Help!

[Ronaldinho123]

Hey guys.

I am 22 years old, and ever since I reached puberty, I have had puffy nipples. I am very athletic, I play soccer 3 times a week and I work out 3-4 times a week, so I have a very trimmed body, not overweight at all.

On June 18th I couldnt take my gynecomastia anymore, so I decided to make the surgery, but now almost a month after I am not pleased at all, and I am already considering another surgery. Because I specifically requested a flat chest, and the doctor told me that he has removed the breast tissue and made a liposuction, but my nipples are still puffy. The right one even more than the left one. I dont know what the hell happened? Why are they still puffy?? Will it go away, or should I do another surgery?? So confused, my biggest wish is to have a completely normal and flat chest.

Please help.

Thanks alot.

[Dr. Elliot Jacobs]

Most guys want to have gyne surgery and look absolutely great the next day, or next week, or so.  Unfortunately, Mother Nature does not work like that.

At less than one month after surgery, it is much, much too early to gauge the results of the operation -- too many things going on, including resolving swelling, etc.

It would be best for you to sit back, relax, do not scrutinize your chest every day and allow 4-6 months for proper healing. Then you can evaluate the results and with your surgeon, decide whether additional surgery or other treatment is necessary.

Until then, spare yourself some worrying and gray hair.

Dr Jacobs

[DrBermant]

Hey guys.

I am 22 years old, and ever since I reached puberty, I have had puffy nipples. I am very athletic, I play soccer 3 times a week and I work out 3-4 times a week, so I have a very trimmed body, not overweight at all.

On June 18th I couldnt take my gynecomastia anymore, so I decided to make the surgery, but now almost a month after I am not pleased at all, and I am already considering another surgery. Because I specifically requested a flat chest, and the doctor told me that he has removed the breast tissue and made a liposuction, but my nipples are still puffy. The right one even more than the left one. I dont know what the hell happened? Why are they still puffy?? Will it go away, or should I do another surgery?? So confused, my biggest wish is to have a completely normal and flat chest.

Please help.

Thanks alot.

Less than a month can be very early after surgery with some techniques.

Posting Standard After Gynecomastia Pictures can help other better understand your concerns.

Early after surgery swelling can mask residual deformity.  How Tissues Evolve After Gynecomastia Surgery depend on many factors. Firm tissues after surgery can be residual gland, fat, but also can just be healing tissues or scars.  Different surgical techniques injure tissues to different degrees.  The body typically needs to heal before considering revision surgery. Rushing into secondary surgery can be a mistake unless there are complications that need to be addressed or the next surgery is component of a staged procedure.  Time to tissues softening can vary depending on the original problem, what was done, after surgery care, Scar Care, After Surgery Compression Garments, and many other factors. Options depend on the problem to be treated. Time can range from 6 months to a year but can vary depending on many issues best explored with your doctor.

I see many patients who complain of residual Puffy Nipple Gynecomastia after another doctor's surgery.  There are many possible problems causing such a deformity.  The most common is remaining gland behind the areola as seen in these Anatomy of Puffy Nipple Drawings.  Check out the images with the link for remaining gland after surgery to see what I mean. 

Here are just a few of the many examples I have seen and treated:

• Revision Gynecomastia After Failed Liposuction By Other Surgeon
• Revision Puffy Nipple Gynecomastia After Failed Liposuction By Other Surgeon
• Revision Gynecomastia After Liposuction and Partial Gland Excision By Other Surgeon.
• Revision Gynecomastia After Partial Gland Excision
  

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia Surgery

[Tay]

I had male breast some years back and in some cases you can be puffy for 2 or 3 month or longer. It's all down to your bodies healing progress so just give it time. I complained about my chest to the doctors too. It took up to six months for my body to properly heal through. Try not to worry too much about it at this stage.

Tay

[Bobby - LAgyne]

i'm pretty sure the docs will answer your question regarding the puffy nipple. but: did your PS cut above the nipples?

[Ronaldinho123]

Yeah, he cut above the nipples, where the scars are. Why? I actually found it weird, because almost every example I have seen of the operation on the internet, the PS has cut under the nipple.

[DrBermant]

Hello again guys.

As mentioned earlier, I did my surgery on June 18th, so now it is about 5-6 weeks after the operation. I have decided to take some pictures to show you guys my condition.
I have taken 5 pictures so you can see, how my scars look after the operation and how my right nipple is very puffy compared to the left one. I dont know what is inside the right one. Anyone who can give me advice on how my healing is going? Slowly/fast?

http://img824.imageshack.us/i/hpim2005.jpg/
http://img714.imageshack.us/i/hpim2006e.jpg/
http://img62.imageshack.us/i/hpim2009.jpg/
http://img825.imageshack.us/i/hpim2010.jpg/
http://img716.imageshack.us/i/hpim2014k.jpg/

I just want to say, that my left nipple is a little more puffy than it looks on the picture. I accidently rubbed it when I was taking the pictures, so it contracted.

Hope to get a response from you.

Thanks alot.

Your limited views are not a complete Standard Pictures for Revision Gynecomastia Evaluation and you also indicate the photos do not show the real contour since you stimulated the tissue before taking them.

I do not use the very long above the areola incision. They just do not look as natural as a much shorter incision at the lower edge. Scars down below tend to fool the eye, while above scars tend to show more. That is why the only time you will see me showing such above areola scars are for patients seeking a revision surgery from some other doctors' misadventures. Scars cannot be erased, just replace with new scars.

Checking what a doctor does before surgery by reviewing pictures on their website or in office is the best way to understand sculpture skills. Unfortunately not all doctors post early after surgery pictures to see how their Gynecomastia Surgery Heals and Tissue Evolves. These examples are typical for my patients.

If your after surgery looks like what you were shown, then perhaps it will turn out well. If the results do not match what you were shown, then asking your doctor why is a valid question. If you did not check before / after pictures before selecting your doctor, well then perhaps a lesson learned.

Good luck on your recovery and healing!

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

[DrBermant]

Hi again.

I just want to give you guys an update on my recovery. It has now been about 2 months since the operation, and my nipples are still puffy. My left nipple is about 2/5 as puffy as it were before the operation, and the right one is about 3/5.
But last week I tried to feel my breast and I noticed, that my left nipple is empty inside. It feels like water or any other fluid, but nothing hard. But my right nipples has a hard lump inside, which I think is breast tissue? He probably hasn't removed it all. I am almost positive, that I will be going through a revision surgery in january, when the swelling is gone etc. But I am hoping my left nipple will become flat over the next months, so I will only be forced to do the right one.

By the way, can alcohol damage my scar or anything? Or can I feel free to go out?

This evolution of tissues after surgery is why I wait before considering revision surgery. All healing tissues change as they heal. It is just better starting from a refined contour right at the end of the operation. Firm tissue after surgery can be scar tissue, healing tissue, and or residual gland. Here is a new page I just completed on the mechanisms of Puffy Nipple Gynecomastia Complication.

Revision surgery is an art form. Checking out specific examples of a surgeon's artistic capabilities can be a critical factor in not worsening a deformity. Remember it is easier to take out than put back.

Drinking can impair know what hurts. Knowing what hurts and what is comfortable protects tissues. Loss of protection can damage healing tissues when they are subsequently pushed beyond what they can take at that point.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

[DrBermant]

Thanks alot for your answer.

I think it is so confusing, because I definitely believe, that a little bit puffy nipples looks better than a nipple that "goes in". Which can happen if the surgeon removes too much tissue, and making the nipple deform. But my nipples are still too puffy for me to "accept them", I dont want them to show when I'm wearing a tight t-shirt. So when I achieve that, I will be satisfied.

In december when I will have reached 6 months after my operation, I will see what they look like at that point and make my decision. I just want a flat chest.

I was wondering - my left nipple is empty inside, but it is still puffy. Could that be because there used to be breast tissue inside, which made the areola area exstract? Which means that my nipple is too big to become flat? Or will it contract? Because I thought about reducing my areola size when I will do my second surgery, in hopes of getting a flat chest.

Thanks alot.

I have seen many variations of problems that can lead to the  Puffy Nipple Gynecomastia Deformity After Surgery. Such issues are best explore during a consultation or a Preliminary Remote Discussion.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia Surgery

[Ronaldinho123]

I had a gynecomastia surgery done 4 months ago, but my nipples are still puffy. The left one is empty inside, and the right one has a hard lump in it. But both are still puffy. I am going back for revision surgery in 2 months, but I was wondering:

Can a reduction of the areola (along with removal of gland and fat inside the nipple) help remove the puffy nipples? If the nipple gets smaller, it will be tighter and less likely to puff out, right?

How long does it take for a scar to heal? Here i mean redness etc. When will it get normal skincolour?

Thanks alot, hope you can help.

[DrBermant]

I had a gynecomastia surgery done 4 months ago, but my nipples are still puffy. The left one is empty inside, and the right one has a hard lump in it. But both are still puffy. I am going back for revision surgery in 2 months, but I was wondering:

Can a reduction of the areola (along with removal of gland and fat inside the nipple) help remove the puffy nipples? If the nipple gets smaller, it will be tighter and less likely to puff out, right?

How long does it take for a scar to heal? Here i mean redness etc. When will it get normal skincolour?

Thanks alot, hope you can help.

I rarely need to use Areola Reduction Surgery as part of my revision. The scars are a significant compromise. What actually needs to take place during

Here are pictures during one of my operations to revise another surgeon's gynecomastia surgery.. This sculpture is an extension of my Dynamic Technique. What actually takes place depends on the defect to be treated and will vary from patient to patient. When there is a defect under the areola and the support under the areola is empty as in this Bursa Crater Deformity with a free floating nipple, adjacent tissue needs to be brought in to fill the defect for results to look good on animation.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

[Ronaldinho123]

Hi again Dr. Bermant.

I was looking up and down on this site, and I looked on the section for compression garments.

And then I started to wonder. When I got my surgery done at this amateur doctor (I've learned my lesson), he didn't give me a compression vest and I had no idea about them until I heard of them on this board. So i have never worn a tight vest after the surgery, could that be the reason why my nipples are still puffy?

And when I go to do my revision surgery, where I will be given a compression vest, do you think my nipples will become flat again? Now that I didn't wear the vest at the first surgery.

Looking forward to your answer.

[DrBermant]

Hi again Dr. Bermant.

I was looking up and down on this site, and I looked on the section for compression garments.

And then I started to wonder. When I got my surgery done at this amateur doctor (I've learned my lesson), he didn't give me a compression vest and I had no idea about them until I heard of them on this board. So i have never worn a tight vest after the surgery, could that be the reason why my nipples are still puffy?

And when I go to do my revision surgery, where I will be given a compression vest, do you think my nipples will become flat again? Now that I didn't wear the vest at the first surgery.

Looking forward to your answer.

Some surgical techniques can result in very long lasting swelling. If there still is an injury component or scar still evolving the compression garments can have value.  Sorry there is much more to skillful gynecomastia surgery than just using compression garments. The puffy nipple complication after gynecomastia surgery:

http://www.plasticsurgery4u.com/revision_gynecomastia/puffy_nipple_complication.htm

can have many possible causes. Residual gland, fat, and scar tissue are the most common.

Hope this helps,

Michael Bermant, M.D.

[Ronaldinho123]

Hi Dr. Bermant and Dr. Jacobs.

I just went to see a respected surgeon about revision surgery. But he told me that he could not do a revision surgery, because there was practically no more breasttissue inside the nipples, so he was afraid that he would ruin the nipples or make them go "inside" the chest. Which of course I dont want to.
But my nipples are still puffy as I mentioned earlier, and I definitely believe that there is some kind of fluid in the nipples, that are making them puffy. Maybe because I didnt wear a vest after the first surgery to keep the fluids out.

But the fact is, that they are still puffy with nothing hard inside them, so I am sure there is fluid of some kind. I asked this surgeon whether or not he was able to put a needle in my nipples and "suck out" the fluid. But he said that he couldnt do that. Is it really true, that you can do surgery and all of those things, but you cant suck fluid out of them with a needle?

I hope you will respond quickly, because I am going to the pharmacy tomorrow to buy a couple of needles and do it my self. I cant see how it could harm. Thanks.

[DrBermant]

Hi Dr. Bermant and Dr. Jacobs.

I just went to see a respected surgeon about revision surgery. But he told me that he could not do a revision surgery, because there was practically no more breasttissue inside the nipples, so he was afraid that he would ruin the nipples or make them go "inside" the chest. Which of course I dont want to.
But my nipples are still puffy as I mentioned earlier, and I definitely believe that there is some kind of fluid in the nipples, that are making them puffy. Maybe because I didnt wear a vest after the first surgery to keep the fluids out.

But the fact is, that they are still puffy with nothing hard inside them, so I am sure there is fluid of some kind. I asked this surgeon whether or not he was able to put a needle in my nipples and "suck out" the fluid. But he said that he couldnt do that. Is it really true, that you can do surgery and all of those things, but you cant suck fluid out of them with a needle?

I hope you will respond quickly, because I am going to the pharmacy tomorrow to buy a couple of needles and do it my self. I cant see how it could harm. Thanks.

Not all surgeons have the same skills for revision surgery. However, there are some situations where revisions are not possible. That is what the evaluation is all about.

Self surgery is a real bad idea. Unfortunately, I have seen the results of real desperate patients who have tried the self surgery route. I currently have one case I am planning to put on my web site to demonstrate the disaster that individual created with his own attempt. The example shows the limitations the prior misadventure can have on my  revision gynecomastia surgery.. The first operation is working on virgin tissues and is the best opportunity to have the best result.

A doctor who has himself as a patient, has a fool for a doctor.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery