Puffy Nipples

[Waterman]

Question for Dr. Jacobs or any other Doctors as well.  I have been considering gynecomastia surgery for sometime now, and have had consultations with 3 different surgeons.  A real eye-opener for me was my consultation with Dr. Jacobs, as he pointed out something that no other surgeon commented on.  Dr. Jacobs' 1st comment was that I had puffy nipples.  I had never really considered my case gynecomastia with puffy nipples, but upon reflection this is what bothers me the most about my condition.  When I am cold or after a work-out my chest looks "normal" to me as my nipples are "erect" ( sorry I do not know how to describe it other than with this term ), and I would be happy to have my chest the same size as it is today if I could get rid of the puffy nipples and my nipples were "erect" all of the time.  My question is do you approach a case such as this differently from gynecomastia without puffy nipples.  My understanding is that the puffy nipples are caused by breast tissue directly under the areola.  Could I have breast tissue excision without lipo-suction?  It seems that the lipo- suction is the most traumatic aspect of the surgery, as many surgeons complete just breast tissue excision with no lipo under local anesthesia.  I would be happy just getting rid of my puffy nipples, and would like to minimize the surgery if possible.  Thank you!---I thought others might benefit from this info. So I posted here rather than messaging Dr. Jacobs privately.

[Dr. Elliot Jacobs]

Gynecomastia is a spectrum -- from just a little beast tissue under a nipples on a thin, flat chest, to huge, pendulous breasts.  Along the line, then can also be puffy nipples on a large breast -- or there can be a large breast with nipples that lie flush with the skin.

I am a perfectionist -- if I see excess tissue plus puffy nipples, then I go after both to try to achieve a much better chest.  You may find a number of posts on this forum in which the surgeon tried simply to remove the puffy nipples -- and the patient ended up with a crater deformity.

Bottom line:  adding lipo is no more traumatic than excision and indeed provides a significantly better contour.

Dr Jacobs

[Waterman]

Dr. Jacobs thank you for your reply....especially responding on a Sunday.  I guess I am trying to find a way to minimize my surgery and recovery, sounds like this will not be possible.  I trust your judgment.  My gynecomastia is a grade IIA.  I am 5'11" and 160 lbs.....hopefully my surgery would be on the low end of the spectrum ( possibly a 60 minute surgery )----as I would have to imagine that the less severe the surgery the easier the recovery will be?  Thank you!

[Dr. Elliot Jacobs]

As I recall, you are young, healthy, have never been significantly overweight and you have moderate gyne.  These are all positive factors for a fairly quick recovery, although there can be no guarantees.

Gyne operations in my hands usually last between 60 and 90 minutes -- but the time is not a factor in your healing.

Chill out -- you are worrying too much.  Yours is a straight forward operation in my hands.

Dr Jacobs

[Waterman]

Dr. Jacobs--  You are right, I am worrying too much.  I just have to take the "leap of faith" that everything will be okay.  I really appreciate all of your advice, now I just have to map out a surgery date that fits my work schedule.  I will be in touch.  Thank you very much!