puffy nipples opinion and advice please

[yelp]

My puffy nipples have been bothering me for about 5 years and are not going away.  I am 19 now.  They have the disc shaped glands underneath and I have almost no body fat.  I am pretty sure I would only need glandular incision. So I've got a few questions:
1)  I am wondering how small the incision can be made, like smallest possible.
2)  I am concerned about scaring, it is difficult to find surgeons who have closeup pictures of only where the incision was made, not the chest contour.  (and also dates past surgery for those photos would be nice).
3)  How much would you charge for this surgery?
4)  If there are noticeable scars the surgery won't be worth it to me.  What are the odds of no noticeable scars and a timeframe for that?

Thanks a million,

Yelp

[Dr. Elliot Jacobs]

You are putting yourself and any surgeon in an untenable position.

There is no way to magically remove your puffy nipples without an incision -- and any incision will leave a scar.  There are only certain things that a surgeon can do in terms of getting a wound to heal as well as possible -- and plastic surgeons are well versed in those maneuvers.  The rest of the healing is up to your body -- and you do not have any control over that.  The scars around the areola tend to heal extremely well -- but every patient is an individual and sometimes it may not heal quite to your satisfaction -- and it is no one's fault and is entirely unpredictable.  Scars go with the territory -- they are a trade-off for a better shape.  If you are not willing to make the trade, then don't do the surgery.

In addition, the length of the scar is determined by the surgeon's needs during the operation.  There is no surgeon that I know of who would willingly go into surgery with a restriction of his freedom to lengthen a scar if necessary in order to get the job done correctly.

If you want to see close-up photos of typical scars, go to my website's photo gallery and look at "peri-areolar scars.

Dr Jacobs

[Litlriki]

I would have to agree with Dr. Jacobs' comments about the scars.  They are rarely an issue, but no surgeon can predict how your scar will appear after the surgery, and each patient heals differently.  If the condition is not severe enough to justify the possibility of having a scar, then it's likely that you don't need to have surgery to correct it.  That said, the photos on my site can be clicked on to enlarge, and the scars are quite difficult to make out in most of the photos. That's because they usually heal very well and in an imperceptible way.  But I still wouldn't guarantee that to any patient.

Rick Silverman

[yelp]

what do you think about an incision under the armpit?  I was told about a procedure where first you use ultrasonic lipo to help break up the gland, and then a multi jointed cutting instrument to remove the rest. 

[DrPensler]

There is an old surgical axiom which states wounds heal from side to side not end to end. The incision needs to be large enough to remove the required amount of tissue. If you are seeking guarantees before surgery no credible surgeon will provide you with one.

[Litlriki]

I make a very short incision in the armpit fold, through which I do liposuction, but this doesn't eliminate the need for excision through the areolar incision in most patients, and certainly not with your sort of "puffy nipple" gynecomastia. 

RS