A small gland left behind on the underside of the nipple... help please

[april24th2007]

I had glandular tissue excision only.  Lipo was not needed I was informed.  Som of the gland was left behind on the underside of the nipple.  To decrease risk of crater deformity.  But it seems as though the surgeon left more than small.  Because i can feel some under the nipple on both sides and my nipples are still pointy/puffy.  It is noticeable even with a t-shirt on.

I would like to ask the respected doctors on this forum for their feedback and input as to what I should do next.  And whether the revision will be a easier surgery with quicker recovery.  Any other thoughts or comments?

Thank you.

[DrPensler]

If your surgery was done in 2007 and you are not happy with the result you can either go back to the original surgeon or get a second opinion. Without any photos or an examination there is not much else I can suggest.

[Litlriki]

I have had to excise a small amount of gland in a few patients over the years for persistent fullness or puffiness, and this is a relatively minor procedure, which I do under local in my office at a very nominal fee to cover expenses.  Recovery is fairly prompt, though I do place some limitations for a shorter time in order to avoid hematoma or fluid collection at the site.  You should speak to your original surgeon and perhaps also get a second opinion before proceeding. 

Rick Silverman

[april24th2007]

Dr. Penseler,

Thank you for your answer.  I should add that I feel some gland on the side of the nipple as well (between my armpit and nipple).  When I lie down flat, its more evident on the sides compared to directly below nipple.  Is this common?  I can put up pictures here tomorrow.

Yes surgery was in 2007.

[april24th2007]

Dr. Silverman,

Thank you for your reply.  It was very helpful.  The surgeon refuses to do the revision for nominal cost like you described.  So I am opting not to go back to him.  From my research, most surgeons do offer exactly like you said - cover cost/expenses only.

I am encouraged to hear that you can do the small revision for remaining gland with local anesthesia.  Would this not be extremely painful though?  With the excision?

Recovery wise this would be much better as well.

[april24th2007]

Good day doctor.  I've attached few pictures for your review and opinion.  Thank you.

[april24th2007]

pic 2

[april24th2007]

pic

[april24th2007]

last pic

[DrPensler]

It appears there is still substantial tissue.

[Litlriki]

I agree with Dr. Pensler.  Not the greatest pictures, but it looks like you'd need liposuction and glandular excision for adequate treatment.

RS

[april24th2007]

Thank you doctors.

May I ask whether the lip is needed for contouring only?  Because if its fat related lip, then I could exercise and burn it off?

Is there any disadvantage to having gland excision with local vs general?

Is it painful ,can patient feel the cutting, tugging etc..?

On a separate note, what does injecting bottom do to the nipples?

[Litlriki]

The tissue that accounts for gynecomastia in most patients is a combination of fat and glandular tissue.  In order to eliminate the tissue most effectively in such patients, a combination of excision and liposuction is needed.  The liposuction is for contouring, but that contouring is an essential part of the operation to avoid contour deformities.  It's possible that you could improve the contour of your chest through diet and exercise, but many men with gynecomastia find that the chest fat is particularly resistant to reduction through dieting.

Local anesthesia without some sort of sedation may limit your surgeon's ability to adequately contour your chest.  Local with sedation or general anesthesia would certainly be more comfortable. 

RS

[april24th2007]

Thank you Sir

[Dr. Elliot Jacobs]

Agree with Drs Pensler and Silverman.  Even though the photos are not great, it does appear that you have residual tissue on your chest as well as under the areola. 

Suggest you get a consultation with a different plastic surgeon (preferably, a gyne specialist).

Dr Jacobs