**Question to DOCTORS** -- Operation techniques

[itsgoingdown]

I'm having surgery soon and want to know what technique is usually used for puffy nipples?

Is liposuction an alternative where you get 4 scars on your chest or is it best to open the nipple towards south and "cut off" the extra gland?

Anyone has ever had lipo?

 

[RyanMace]

I am not a surgeon, but they usually combine lipo + gland excision, seeing as puffy nips are usually caused by gland.

[DrBermant]

I'm having surgery soon and want to know what technique is usually used for puffy nipples?

Is liposuction an alternative where you get 4 scars on your chest or is it best to open the nipple towards south and "cut off" the extra gland?

Anyone has ever had lipo?

"Puffy Nipples" is a common public term for gynecomastia. 

The problem is the the term puffy nipples is a phrase that mean so many different things to so many different people.  Words just do not convey the actual problem very well - images do a little better, but still are not the same as an actual in office evaluation with your doctor.  This Gynecomastia Picture Gallery of Puffy Nipples begins to show some of the various problems patients have called "puffy."

Putting up pictures (using standard views before and after surgery) is one way to discuss what the problem was before surgery and what has happened.   Options depend on what is really going on.

Let us try to look what I mean by the problem of the words only descriptions.  "Large nips", "puffy nipples," "puffed nipples,"  and "puffy nips" are a common terms many give to a problem that extends to the region about the areola.   The nipple is actually the central raised structure inside the pigmented areola.

"Puffed nipples" can be a problem for some that involves long nipples above the areola where nipple reduction alone helps.

"Puffy Nipps" can be a problem behind the areola that can take many forms.  The deformity is usually a varying combination of fat and gland.  The gland can be firm or soft, spread through fat, or be a condensed mass.  There is a thin muscle under the areola skin that can flatten tissue when stimulated. Unfortunately it is impractical to keep stimulating these muscles.

In many of these patients with "puffy nipples," there was no firm tissue under the areola, just fat and soft gland.  Here is one example of puffy nipples in a muscular male.  Here is another example of   puffed nipples.  Here is another patient with puffy nipple gynecomastia.

"Puffy Nipples" can also be a combination of gynecomastia and big nipples.

I prefer my Dynamic Technique that adapts to the problem found during surgery to minimize such issues as residual deformity after surgery.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[itsgoingdown]

If you choose to use lipo on your patient Dr. Bermant, would you make:

1) extra holes (3 or 4) around the chest for removing the fat

or

2) make one bigger hole on the areola and use this to remove all the gland and fat from this major hole?

as a conclusion to my question, for a bodybuilder with only puffy nipples how many holes do you make in order to remove the fat?

[itsgoingdown]

anyone?!

[DrBermant]

If you choose to use lipo on your patient Dr. Bermant, would you make:

1) extra holes (3 or 4) around the chest for removing the fat

or

2) make one bigger hole on the areola and use this to remove all the gland and fat from this major hole?

as a conclusion to my question, for a bodybuilder with only puffy nipples how many holes do you make in order to remove the fat?

With my Dynamic Technique, I typically start at the edge of the areola with a tiny incision for the Tumescent Cannula to determine the extent of gland.  When I find gland the incision I make is still very small usually 1.6 - 2.0 cm.  I need larger incisions (usually about 3.0 cm) for an Internal Lift Male Mastopexy.

Unless I am performing a major Skin Reduction Chest Lift as with my massive weight loss patients, it is rare that I make more than one incision on each side.

I deal with many Body Builders with Gynecomastia, most have little fat and mostly gland.  Liposuction just does not do well for gland.  You can see many examples of typical incisions I have used for my patients on my website.


Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture