Hello one of the mistakes i regret dearly is the lack of knowledge on the existence of this site. I have dealt with gynecomastia since i was 15 years old, all the way up to 21 years old. Now there seems to be 3 separate conditions people are describing here one is the "lump" and the other one being puffy nipples and lastly excess fat in the chest area. I have had all 3, i cant really describe the disturbance i had to carry on for many years. I have puffy nipples in both sides, have a obviously larger lump/glad on my left chest, not much on the right side but still have puffy nipples. Long story short when i became 20 years old and had enough money i decided to consult a surgeon that i know from work to help me out. I placed my trust in the doctor since he seemed very calm and positive about his approach for my operation. What he ended up doing is basically a lipo suction, seeing how sure the doctor was i had no problem going along the procedure.
Its been 6 month after the operation, and like u would of guessed i am not 100% happy. Even though lipo did help ease my headaches by alot and helped me re-gain confidence it still not done yet. Excess fat was removed ill say close to 75% but the lump or that gland tissue was still there; even more visible to the point where if raise my hand up you can see a round ball-type lump on the near left side around the nipple.
Today i talked to the doctor and explained him what is still troubling me. He suggested yet another lipo to "even out" that side where i have that large lump at. From what ive read here many that go for lipo 1st ended up getting a excision of the gland to completely get rid of it.
What i would like is if one of you doctors helping out in these boards could help me decide what is it exactly that i need to do to get rid of this issue that i just wanna put behind me already. I dont know much but my doctor suggested that if indeed he removed that glad hes going to have to do some cutting, as well as the risk of not having feeling in the nipples and worst of all the chance that after its been removed there will be a "dent" like look to my chest where the glad had been at. Is he correct? What is it that i need to do to get rid of the puffy nipples that cause that horribly impression of male breasts? Are there any cons pursuing this removal? Does the fat-like lump have anything to do with the puffy nipples?
THANKS Any info on my case will be immensely appreciated !
i know some of my question have been probably discussed but i would like a direct answer to my specific issue.
Posting
Standard After Gynecomastia Pictures or even better
Standard Movies to Document the Male Chest Contour Deformity can help others better understand your concerns. The movies are harder to make but are much more revealing.
I am happy to provide specific advice during a consultation or a
Preliminary Remote Discussion where after learning about the original problem, what was done, medical history and other important details I can diagnose what went wrong, offer a discussion of risks, benefits, and alternate methods of care. Specific advice by a doctor in a forum like this is establishing a doctor / patient relationship for which the doctor could be held responsible and reckless without such details.
Learning how a doctor manages male chest contouring and more specifically puffy nipples after inadequate gynecomastia surgery is a valid concern. This is exquisite surgical artistry, look for specific before and after surgery pictures, movies, and certainly how the tissues move to best understand that doctor's skills.
If a doctor says they cannot manage such a deformity without a
Crater Deformity, look for before and after surgery images to see the results of their methods.
Prevention, in my opinion is the best starting point. I just do not get such residual puffy nipples with my own surgery. Yet I see many patients unhappy after surgery by other doctors. Even subtle
Puffy Nipple Gynecomastia can detract from a cut look on the male chest. The key to the many residual puffy nipples after gynecomastia surgery that I have seen is residual gland, scar, and sometimes fat. The gland is a major culprit. That is why I evolved my
Dynamic Technique targeting gland first. There was a body of plastic surgery literature that said, liposuction first, then if there is some gland go for it, but do not take too much because it will crater. For years I saw patients from other doctors who just did not look good with that method. By targeting gland first, I remove that firmer tissue that tends to look worse when the areola muscle relaxes
Puffy Nipple Deformity Can Be Hidden by Areola Muscle Stimulation, muscles flex, or tissues move. What is the sense of contouring the chest that only looks good in a cold room or in a still photograph?
Although fat tends to be soft, gland and scar firm, I have seen firm fat and soft gland and scars. That is why I prefer to evolve what needs to be done for this sculpture as the operation unfolds.
Warning Graphic PicturesWith revision surgery I target the firm residual deformity first. I then pick from an artist's pallet of surgical options to continue contouring the chest. This often involves my
fat flap sculpture, moving nearby fat preserving the blood supply to replace the firm deforming structures with soft fat. By waiting until I find out how much gland should come out first, remaining fat can be contouring tool. Liposuction first, and that resource may be gone. Have a revision operation by liposuction alone, and you may be burning reconstruction options.
Here are some specific examples of my methodology and approach to this problem of deformity after liposuction alone deformity:
all after other surgeons' work. I have seen many many other patients unhappy after contouring from other doctors who claimed that their liposuction alone was enough to manage the gynecomastia. In the
Anatomy of Gynecomastia there are fingers of gland that run through the fat. Unfortunately all forms of liposuction, Vaser, Ultrasonic, Power Assisted, "Smart," sharp cutting cannula all preferentially will target the softer fat first. Suck out the fat first, and the fingers of gland condense behind.
On this page of Puffy Nipple Anatomy, hold your screen cursor over the link "
Remaining Gland after Gynecomastia Surgery" to see residual gland that can be left behind when working using liposuction from a remote site that depicts on common problem I have seen in such cases. Then look at the gland / scar tissue complex in each of the revision cases I have posted to see what I mean.
You can see some of the very large
Gland Mass of Gynecomastia I removed from patients and yet achieved a great contour without the crater. Check the link on each of the gland examples to see details of that patient with before and after surgery pictures / movies. The fat flap is a powerful tool, when there are adequate local resources.
Here is another patient who I performed
Revision Gynecomastia Surgery after not enough gland was removed. Check out the size of the gland / scar tissue that was causing the defect on that page. I can also often revise the surface scars during revision surgery, check out the close up pictures on that page. Most revealing however, are the
Videos before and after that patient's revision gynecomastia surgery. You can also listen to the emotional experiences of having repeat surgery. Many of my patients tell me that my revision was much easier than their first surgery by their other doctor.
Hope this helps,
Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery
