Skin removal and nipple placement

[paul786]

Hi I have had a bad case of gyne

Had it removed 4 months ago and I am due to have a revision
at about 6-8 months to remove skin.

seen the surgeon today told him I wasn't happy about my nipples being an inch below lowest border of my flexed pecs

in short if I put my finger on my nipple and flex my chest I don't feel the muscle contract if I move 1 inch up and flex I hit the bottom of my pec and there's where expect the nipple to be.

I am correct in saying the nipple should be  on the lower park of the pecs?


when I look at photos of mens chests the nipples are always on the pecs.

my surgeon took a tape measure and measured down from my collar bone said 23cm perfect.

Surely Its a bit more technical than that?

[Dr. Elliot Jacobs]

You are correct.  A male nipple should always be just above the infra-mammary fold -- ie on the lower aspect of the pec itself.

Measurements mean nothing -- it all depends on the size of the patient.

Sure sounds like you should talk with your surgeon about re-location of the nipple to a more appropriate spot.

Dr Jacobs

[paul786]

Thankyou Dr Jacobs

[DrPensler]

Measurements are useful as a guide. Average measurements represent the position in the 50th percentile of patients. By definition half of the patients require shorter measurements while half will require larger distances of repositioning , to apply the specifics to your case. A long and narrow build would require a different distance compared to a short and broad build.

[Litlriki]

I am aware of studies that demonstrate nipple position in women with "perfect breasts" falling within a certain range (18 - 23 cm from the sternal notch), but those numbers have no applicability in men.  I have engaged in this discussion with colleagues as well as at meetings, and to the best of my knowledge, there are no similar studies that have been done in men. I would welcome information from the other surgeons if such a study exists. 

Even with such numbers, if the nipple is sitting below the pectorals, this would look strange and would require repositioning in some way.  A nipple sitting at the lower pectoral border, but still above the fold, can be normal, and this position is not uncommon in men with very hypertophic pectorals major muscles. I read once that such positioning is a sure sign of steroid use, but I would have to argue this based on personal observation.

Rick Silverman

[George Pope, M.D.]

I agree with the other docs here.  I've not seen any description of nipple position in males. I do think the chest looks best when the nipple sits just below the center of the pec muscle, just a few cm's above the inframammary fold.  I usually measure 4cm up from the fold and mark that as the Bottom of the areola, then step back and get a good look before committing to that.  It will depend on overall dimensions of the chest, but I think that's a good rule of thumb.

Dr. Pope, MD

[Miguel Delgado MD]

This is a very good question and one that seems to be worked out on females almost perfectly but in men much more difficult.  Gynecomastia and massive weight loss has help us focus on the issue. In general, the error tends to be placed to high and medial.  Doctors on this panel are much more experienced tend to have there formula with the edge of the pectoralis muscle being a landmark, which is always above the fold.  I agree and at the level or hight of the 4th intercostal space is fairly good.  A great study was performed at the American University of  Medical Center Beirut, Lebanon.  The article appeared in Journel of American Plastic surgery  in 2009.  This study I found interesting because it based the nipple point to the middle of the chest or sternal notch and armpit to the belly button.  This is the article link http://journals.lww.com/plasreconsurg/Fulltext/2009/04000/Determination_of_the_Nipple_Areola_Complex.52.aspx

The important points are described below.  This is fairly technical but this is some of the science in the gynecomastia world. You must discuss your nipple position with your PS and make the decision on how it looks to YOU!  One last point, if your PS is performing just gland excision and liposuction, he or she has no control over the nipple position.  It will tend to adjust in a natural way.

Our results demonstrated that the optimal male nipple vertical (SN-X) and horizontal (N-N) coordinates can be determined with only two easily measurable distances, U-AX (umbilicus–anterior axillary fold) and SN-U (suprasternal notch–umbilicus), which are in golden proportion (golden number = 1.618, golden number reciprocal = 0.618). Internipple distance can be calculated with 95 percent accuracy (N-N = 0.618 × U-AX), and the distance from the suprasternal notch to the horizontal NN plane can be determined in 80 percent of cases within a range of 3.33 ± 1.25 cm. The upper limit of this range is SN-X1 = SN-U – (0.618 × SN-U) = 0.618 × U-X1, and the lower limit is SN-X2 = 1.618 × N-N/2 = U-AX/2