Nipples Flattening Post-Surgery Timeline

[hitman200x]

Hey everyone, I am new to the board, but wanted to share and get some feedback. I'm 24 yrs old, very good shape, workout religiously, and just had my gynecomastia surgery on Monday the 13th. It wasn't so much sagging of the breast tissue that I needed to have worked on, but these ridiculously puffy nipples that pointed out of every shirt and just looked very odd.

I had the surgery, and now it's a few days later and I'm noticing that while I can definitely tell where the lipo/excision occurred, the nipple area is still a bit puffy. I've been wearing under armor ever since the surgery because I was told that the skin needs to be forced into tightening over the now open space in the pecs, but my concern is that, when I don't have the under armor on and just put a shirt on, I can still see the puffiness sticking out.

How soon should I expect everything to be flattened? I know not everyone heals in the same way, but is this a 2-3 week thing, or is it going to be like 6 weeks before I'm not self-conscious taking my shirt off?

[drdeadlift]

Be patient mate, the results will come!

I only had my surgery 4 weeks ago so I am still healing, but the nipples are pretty much flat now, despite some scar tissue. They were a bit puffy up until about 2 weeks post op where they started to really flatten out and it seems that they are getting flatter, smaller and darker every day.

The puffiness you are seeing I would suspect is just swelling, fluid etc it will go away just make sure to wear your compression vest 24/7, it does really help.

Did your PS give you a compression vest/band to wear?

[hitman200x]

The PS said I could wear a compression vest, or I could go to Walmart/Target and buy the under armor shirts, but a size too small, to ensure it is tight enough. So I had the surgery on Monday, and then had the wrap they put on me Mon-Tues. Wed I had that removed and since Wed Ive been wearing the under armor 24/7 except for showering and such.

You're probably right with the swelling/liquid. I'll post pics later to show what I mean. One thing that might be different is my PS didn't have to make any incision on the nipple. He used lipo and then some type of new shaving instrument that prevented scarring.

[George Pope, M.D.]

drdeadlift is right.  It takes a number of weeks, usually a couple of months, before you'll see your final result.  And if you have any bleeding into the tissue it could take longer than that.  Compression immediately after the surgery is important, and I have all of my gynecomastia patients wear a compression vest for 2 weeks day and night, followed by a tight spandex shirt such as Underarmour for the following 4 weeks or so.  You may want to ask your surgeon about compression; sounds like he/she recommended at least the tight shirt.

But you need to be patient.  You won't have that flat chest overnight.  Just follow your surgeon's instructions and keep all follow up appointments.

Good luck-

Dr. Pope, MD

[hitman200x]

Dr. George,

My surgeon told me during the initial consult about the compression vest but suggested that I instead use under armor a size too small. So since I wear size large, I bought a bunch of size medium under armor shirts and have been wearing them 24/7 except when showering, obviously. One thing that would help me be patient is understanding what is happening to the body.

As far as I understood, what happened was that he removed a clump from each pec. The clumps were what was causing the mid-chest and nipple to protrude. Now, with no clump there, there is a lot of open space that doesn't know what to do. By compressing I'm essentially forcing the skin to tighten over the new open space. But how then are the nipples still puffy? Is there still liquid in the breast?

[George Pope, M.D.]

When the breast tissue was removed, it was done with either a scalpel (doubtful) or scissors, or more likely, electrocautery, to minimize bleeding.  Regardless of the method used for removal, all of the surrounding tissue was "traumatized", if you will, and reacted by swelling up.  Think about what happens to your eyelids and cheek if you get punched in the face, or to a finger if it gets injured.  There is a reaction by the tissue which causes it to swell.  The use of compression garments helps keep the tissue so tight that it limits the degree that the tissue can puff up.  But there is still swelling that occurs, even with a tight shirt or vest.  If your surgery was limited to the nipple areola area, that's the area that will swell.  So for awhile, it may look like nothing was done (you may look like you did before the surgery).

Dr. Pope, MD

[hitman200x]

Dr. Pope,

Thanks a ton for the answer. That is essentially what I figured, so it's good to get confirmation. The next one I have would be when do you stop wearing the compression vest/under armor? I had figured about 3-4 weeks or so, but is there a broad or general time when the swelling should subside, if everything is done correctly? And additionally, does working out in the swelling period have any particular effects? I'm obviously not going to bench press tomorrow, but I have workout withdrawal at this point and going for walks is going to get pretty boring soon!

[George Pope, M.D.]

I tell my patients: compression vest for 2 weeks, then tight UnderArmour shirt for the next 3 to 4 weeks.

No bench pressing for 6 weeks.  Light aerobic activity after about 2 weeks, heavier the next week.  Keep in mind that the more overheated you get during the first 6 weeks of recovery, the more you're going to swell in the chest area.

Vigorous activity in the first couple of weeks could even lead to bleeding.

Dr. Pope

[DrBermant]

Hey everyone, I am new to the board, but wanted to share and get some feedback. I'm 24 yrs old, very good shape, workout religiously, and just had my gynecomastia surgery on Monday the 13th. It wasn't so much sagging of the breast tissue that I needed to have worked on, but these ridiculously puffy nipples that pointed out of every shirt and just looked very odd.

I had the surgery, and now it's a few days later and I'm noticing that while I can definitely tell where the lipo/excision occurred, the nipple area is still a bit puffy. I've been wearing under armor ever since the surgery because I was told that the skin needs to be forced into tightening over the now open space in the pecs, but my concern is that, when I don't have the under armor on and just put a shirt on, I can still see the puffiness sticking out.

How soon should I expect everything to be flattened? I know not everyone heals in the same way, but is this a 2-3 week thing, or is it going to be like 6 weeks before I'm not self-conscious taking my shirt off?

The time line for nipple being flat after surgery is technique and after care dependent. I typically do not stop my operations until I have achieved the contour goals and limitations set out before surgery. The results are immediate as you can see in the many examples posted of early after surgery progression such as these Pictures of healing and recovery after gynecomastia surgery.  There are many other examples on my site.

The contour right after surgery can also be obscured by the Swelling And Bruising After Gynecomastia Surgery. For my patients, this is also typically minimal. Peak swelling is in the operating room. To achieve this contour optimization requires certain surgical techniques and After Surgery Compression Garments. Some brands are just woefully inadequate resulting in much more swelling and bruising. Certain brands in my opinion are not satisfactory for me to achieve the results I have shown. I prefer to vary the timing for this compression based on the problem I am sculpting. However, I break this down into Stage 1 and Stage 2 compression. Lightweight compression does not help with scars as well as these Second Stage Compression Vests.

Puffy Nipple Complication after Gynecomastia Surgery can also be due to how the surgery was done beyond swelling issues. In this case, once swelling goes down the residual contour problem will remain.

Each doctor has his / her own techniques and how that method evolves over time varies. The results I document for my patients of course do not apply to other methods. How your tissues should progress, are best understood by seeing examples of your surgeon's work.

Hope this helps,

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

[hitman200x]

Dr. Bermant,

My surgery was done specifically for the puffy nipples, and not anything else, as my surgeon informed me that I had very little fatty tissue on the breasts aside from the area behind the nipple. I can see after 7 days that it should look good after the swelling goes down, but I don't know when that will be, and that is unnerving. I understand now, however, that my results were not going to be immediately perfect because of the swelling behind the operated area. It's just the feeling of not knowing what it will look like when the swelling subsides that is bothersome. Maybe they aren't puffy at all and are smaller. Or maybe I spent $7000 between the surgery and hospital and will see only minor improvement. My followup to get stitches/stery strips (?) removed is tomorrow, and I'll see how the doctor thinks I'm healing.

[DrBermant]

Dr. Bermant,

My surgery was done specifically for the puffy nipples, and not anything else, as my surgeon informed me that I had very little fatty tissue on the breasts aside from the area behind the nipple. I can see after 7 days that it should look good after the swelling goes down, but I don't know when that will be, and that is unnerving. I understand now, however, that my results were not going to be immediately perfect because of the swelling behind the operated area. It's just the feeling of not knowing what it will look like when the swelling subsides that is bothersome. Maybe they aren't puffy at all and are smaller. Or maybe I spent $7000 between the surgery and hospital and will see only minor improvement. My followup to get stitches/stery strips (?) removed is tomorrow, and I'll see how the doctor thinks I'm healing.

Yes, it can be anxiety provoking to wait to see how tissues will look after swelling resolves. That is why I spent so many years trying to evolve my techniques to minimize swelling / bruising so that my patients can be more comfortable both physically and emotionally after surgery. I also many years ago migrated away from removable surface sutures to dissolvable one as part of this process. For my patients, I leave the steristrips on for quite a bit longer as a reinforcement and protection of the healing tissue. Although it might make for better pictures, I will leave such strips until the tissues can better take the stress.

Being patient can be difficult, but is the best way to deal with this evolution of tissues. Documenting it with your own photos can help others better understand how your doctor's technique tends to progress over time.

Good luck on your continued healing.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction