Areola size post OP

[Ravens]

Hey guys. I had my surgery about a year and a half ago and although I couldn't be happier that the gyno is gone, I still feel as though my chest is my #1 worry area. I suppose I should have asked for areola reduction as well, but that's in the past.

Anyway, the size of my areola is my newest obession. I am currently about 20 pounds over weight and I have been noticing that the size of the areola seems to take shape after the fat deposit on my lower chest. Its perfectly normal sized when my nipples are erect, but it seems to expand horizontally (a little bit vertically too, just not as much) when they are normal. That being said, I am currently looking to start losing weight at the rate of about 1-2 lbs a week and I was wondering if there is any chance the areola might shrink with the fat.

I think the main reason this is such a big concern for me is that after surgery, I began working out and have gained a significant amount of muscle since. My surgeon even compliment the how much I ahd developed my pectorals when I went to do visit him a year later. But the problem is... when my nipples are erect, I think my chest looks incredible. When they are normal and the areola expands, however, the bottom of my chest seemingly loses any definition that was there when erect.

Anyhow, enough of my rant. Summary being : What should I expect after losing around 20 pounds at a rate of 1-2 lbs a week?

[Dr. Elliot Jacobs]

It should, in general, be better.  Unfortunately, weight loss cannot dictate where the weight will be lost.  If you lose significant amounts of weight, every fat cell in your body should shrink a bit -- including the ones on your chest.

Net result would probably be a slight reduction in your areolar diameter -- but not a significant reduction.

Dr Jacobs

[DrBermant]

Hey guys. I had my surgery about a year and a half ago and although I couldn't be happier that the gyno is gone, I still feel as though my chest is my #1 worry area. I suppose I should have asked for areola reduction as well, but that's in the past.

Anyway, the size of my areola is my newest obession. I am currently about 20 pounds over weight and I have been noticing that the size of the areola seems to take shape after the fat deposit on my lower chest. Its perfectly normal sized when my nipples are erect, but it seems to expand horizontally (a little bit vertically too, just not as much) when they are normal. That being said, I am currently looking to start losing weight at the rate of about 1-2 lbs a week and I was wondering if there is any chance the areola might shrink with the fat.

I think the main reason this is such a big concern for me is that after surgery, I began working out and have gained a significant amount of muscle since. My surgeon even compliment the how much I ahd developed my pectorals when I went to do visit him a year later. But the problem is... when my nipples are erect, I think my chest looks incredible. When they are normal and the areola expands, however, the bottom of my chest seemingly loses any definition that was there when erect.

Anyhow, enough of my rant. Summary being : What should I expect after losing around 20 pounds at a rate of 1-2 lbs a week?

Unfortunately, weight loss after surgery is not predictable, you cannot pick where the weight goes on, nor where the weight comes off. Men tend to put fat first on the breast and belly. We take the fat off those regions last. If someone has their chest contoured even before weight loss, then loses weight in a normal male pattern and does not lose as much in the chest region, it can look like the breasts came back.

Losing weight can help with the fat of gynecomastia but does not help with remaining gland / scar tissue. I have seen many cases that losing weight that unmasks the remaining gland / scar tissue. Patients feel better about their bodies at the lower weight, but how the contour looks can be unpredictable.

Losing weight can also result in loose skin. How well skin adopts to the new size can vary depending on many factors.

I just operated on a patient who lost 15 -20 pounds after sending me his photographs before surgery. A major amount did come off his chest for that patient, but that was before surgery. But from the picture point of view, it really was as if I was looking at 2 different people. Now the amount of weight that makes a difference can vary from individual to individual.

For my patients, I advise them to get to a weight they are comfortable with before surgery.

As a surgical sculptor I prefer using a coarse tool first and then one of refinement. Losing weight is that coarse tool. Plastic Surgery is best reserved for refinement.

I also have had patients who lost weight after surgery. Some got away with it and were happy with their new contour. For others it came off in a fashion that left results less satisfactory, you just cannot predict. The unhappy patients were those from other doctors' prior surgery, and then had lost the weight. Most said they were upset that they had not been educated about such issues before surgery. Education is knowledge and puts the power with the patient. Although sometimes you can get away with it, or use revision surgery at additional cost, to me it seems just more logical to be patient and work on the weight first, then the surgery.

There is an exception to this format. The extreme athlete / bodybuilder. For these patients, I prefer to sculpt their off season weight. As body fat gets extremely low, healing can be impaired and there are few resources left to target gland first. A great example is this Competition Body Builder with Gynecomastia. Look at his body fat before surgery in his competition posing, the fat he had during surgery (obviously more), and the competition posing after surgery.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[rayray416]

I had my surgery about 3 months ago.  I find that my nipples did not shrink as much as anticipated and the right one still has some puffiness to it.  I am hoping this will change, but am losing hope of that.  My right side was always worse than the left.  According to my surgeon, he guaranteed me a flat chest once finished.  I have a follow up with him soon and plan to ask about this problem. 

I have worked out since I was 18 (now 32) and always had a decent build, but my chest was never tight.  Like you, I felt that my chest always looked better when the nipples were erect and unfortunately following surgery I still feel that way.  A bit disconcerting, but spent too much money to leave it at this.