Burning sensation Day 18

[Average Joe]

Day 18 post-op gyno surgery with liposuction extending  under my arms.  The overall look seems great with no bruising at all. But, is it a normal sensation to still have a tight, prickly, burning feeling under my arms whenever they rub against my sides?  My chest area is fine maybe because nothing is rubbing against it?  That sensation in my armpits and sides is driving me nuts!  The skin is not hot or red (just slightly swollen) and am not running a fever.  My next post-op appt is in one week and will ask my surgeon at that time, just hate to bug him now unless it is an emergency.  Thanks for your time.

[Litlriki]

Following liposuction procedures, it's common to have unusual sensations in the operative area due to nerves recovering--kind of like when your leg wakes up after it falls asleep and you feel tingles and shooting pains, etc.  You can help with desensitization of the area by rubbing it with a terrycloth or other rough material and treat it normally, so that it doesn't remain hypersensitive.  It will take time for this to resolve completely, and there are medications that can be used if needed, but generally it's just a matter of time.

Rick Silverman

[DrPensler]

I think its typical to have slightly altered sensation after liposuction  and / or surgery anywhere on the body. When both are performed in the same area I think its more the rule than the exception.

[Average Joe]

Thanks so much for your comments doctors!  The terrycloth advice seems to be working, feels like heck when I am doing it but afterwards seems to desensitize it somehow.  Everyday seems to be getting a little bit better.

One more question please:  The overall look that I got seems to be looking great except for one detail.  The areolar size reduced dramatically but the long nipples are still there.  My fault, I never said anything about it so it wasn't addressed.  I am approaching 1-month post op now.  What would be your "perfect" time to inquire about a revision just to reduce nipple length?  Is it best to wait until all healing has taken place from the gyno surgery or just go in there now and wack them off?

[DrPensler]

Without a photo I cannot comment but if you are concerned you should definitely bring it up with your surgeon.

[Average Joe]

Doctor, here is a pic at 1-month post op gyno/lypo that demonstrates undesirable nipple length.  Would you recommend full healing before this is addressed, or would it be best to just go and trim them down now while there is reduced feeling and sensation?

[Litlriki]

You can have the nipples addressed any time, really, and the sensation issue isn't vital, since you'll have to have some local anesthesia for that anyway.  I do that in my office when needed, though it's not a common complaint. 

RS

[Average Joe]

I am currently at around 4 months post-op now and everything is turning out great except one thing.  The extruding nipples are really bothering me and would like to just have them removed altogether.  My surgeon feels like I am making something out of nothing but I am not.  Not the areolar portion but the nipples are too big, they are bigger than my wife's (pea size) which is not something to brag about.  I am planning on getting a revision by another surgeon.  Can you give me any information about the procedure itself?  Can I have the whole nipple removed while leaving just the areolar complex alone?  Is there any harm in doing so, because I could care less about sensation, numbness, etc.  To me nipples are an unneccessary accessory for a man especially when they are large.  I just fear having a 2nd surgery and they are not reduced enough.  Thanks in advance for your advice docs!

[Dr. Elliot Jacobs]

Reducing the ultra-projecting nipple is something that can be done at the same time as standard gyne surgery, or, as in your case, anytime after that.

It is a relatively straight forward operation and is performed under local anesthesia.  As Dr. Silverman said, since your skin may still be somewhat numb, this may be an ideal time to consider doing it, since your would not feel the needle pricks of the local anesthetic too much.

I would caution you about seeking to remove everything.  The normal male nipple is a nubbin, a small hill -- not huge but not absolutely flat either.  Make sure you find a surgeon who is familiar with this.

Dr Jacobs

[Litlriki]

I agree with Dr. Jacobs--your goal is a "normal" chest.  A normal chest has nipples.  An areola without a nipple in the center would likely look a bit peculiar.

RS

[Average Joe]

Thanks so much for your expertise and comments doctors!  Can you comment on a typical surgical approach so that I may be a bit more informed?  Is it as easy as just amputating the top portion like a projecting mole or is it something more involved?  I have read something about v-flaps of skin?  Just seems like it would be easy just to cut off the top portion, or does it grow back?  Thanks again!

[Dr. Elliot Jacobs]

Kind of difficult to describe but here goes:  yes, I do amputate the tip, but then the nipple would appear similar to a volcano -- with slopes and a flat top.  To deal with the flat top I do remove small "V"-shaped portions of skin to reconstruct a rounded nipple tip.  This is then sutured with very fine, quick dissolving sutures.

Hope you can visualize this.

Dr Jacobs

[Average Joe]

Perfect, thanks!!!

[Average Joe]

Thank-you Dr Jacobs for comments describing your technique.  One last question for you, how much would I expect to pay for (just nipple reduction) surgery as you described?  I had a surgery consult yesterday and the surgeon described his technique involving removing the outside skin and telescoping the nipple down with sutures.  It seems to me a very costly intricate  technique and maybe should be reserved for females, since they may want to maintain sensation and lactation capability.  I expressed this to him but he insisted this method although time consuming produced the best results.  The total cost I was quoted was $2,000 which to me seems a bit excessive for just removing nipple length.  Does that price seem reasonable for such a simple procedure?  Please, what are your thoughts?

[Dr. Elliot Jacobs]

The fees charged by surgeons are what they feel reflects the amount and complexity of the work -- and there are huge geographic differences as well.  I do not feel that the quoted fee is excessive. 

I am familiar with the technique that you described -- it works, too.  Every surgeon has his own preferences.  My technique actually takes up as much time and effort as the previously described technique.

Dr Jacobs