Which type of incision?

[rich1989]

Hey all,

Im new here and have a mild form of gyne, with quite puffy nipples. Im going for my op on wednesday and my surgeon has proposed to two types of incision to me depending upon my preference. Before I talk about my decision, Ill describe myself abit as my cameras broken.

5"8, 160pounds, have abit of fat but my problem is my nipples being puffy, and also (I think) large in area.

My surgeon has told me that he can either perform an incision doing a half circle on the inferior border of the nipple. (9 oclock to 3 oclock) and through this cut remove some of the glan lying underneath the nipple. This wud reduce the puffiness of the nipple.

When I asked him about reducing the nipple diameter, he also mentioned a full circumferential technique, which is used to remove some of the nipple skin, and so can also reduce nipple area aswell as puffiness. The problem is that these scars tend to be considerably worse than the half (9 til 3oclock) incision.

So the ultimate question is do I gamble on the scars and settle for a smaller nipple area and hope for the best? Or do I go for the flatter nipples.
My nipples are approx 33mm in diameter, which Im told is not massive and so the scarring associated with the full circumferential incision coulf easily outweight the benefits of reducing the nipple size. To be honest I think I would be very happy if I could have flat, slightly smaller nipples. Has anyone else been in a similar situation? I know it's hard to judge without pictures, but any advice is welcome.

Thanks!

[Dr. Elliot Jacobs]

To me, there is really no choice.  I do not like scars totally around the nipples -- they tend to spread out and sometimes distort the circular shape of the areola.  And once they are there, there is no going back except, perhaps, to tattoo over/around them.

Best recommendation is to have a 1/2 circle (ie peri-areolar incision) which will provide access to remove the puffy tissues.  And then, perhaps if needed, some lipo in the surrounding area (sometimes we do this without suction -- just to stimulate the skin to tighten) to tighten the skin.  The nipple diameters would decrease spontaneously.  And as the nipple diameter shrinks, the peri-areolar scar will also shrink.  Its a win-win.

Dr Jacobs

[DrBermant]

Hey all,

Im new here and have a mild form of gyne, with quite puffy nipples. Im going for my op on wednesday and my surgeon has proposed to two types of incision to me depending upon my preference. Before I talk about my decision, Ill describe myself abit as my cameras broken.

5"8, 160pounds, have abit of fat but my problem is my nipples being puffy, and also (I think) large in area.

My surgeon has told me that he can either perform an incision doing a half circle on the inferior border of the nipple. (9 oclock to 3 oclock) and through this cut remove some of the glan lying underneath the nipple. This wud reduce the puffiness of the nipple.

When I asked him about reducing the nipple diameter, he also mentioned a full circumferential technique, which is used to remove some of the nipple skin, and so can also reduce nipple area aswell as puffiness. The problem is that these scars tend to be considerably worse than the half (9 til 3oclock) incision.

So the ultimate question is do I gamble on the scars and settle for a smaller nipple area and hope for the best? Or do I go for the flatter nipples.
My nipples are approx 33mm in diameter, which Im told is not massive and so the scarring associated with the full circumferential incision coulf easily outweight the benefits of reducing the nipple size. To be honest I think I would be very happy if I could have flat, slightly smaller nipples. Has anyone else been in a similar situation? I know it's hard to judge without pictures, but any advice is welcome.

Thanks!

I prefer neither unless there is a good reason. When significant gland is present, I start at the edge of the chest skin areola interface. That is a great place to fool the eye about a scar. Typically for normal gynecomastia, I need only one small incision on each side often about 1.6 cm (a little over 1/2 inch). This is much better than needing 4 incisions or much longer incisions that can show to a much greater degree. My incision tends to be longer when I am performing such operations as my Male Mastopexy Internal Chest Lift or Revision Gynecomastia Surgery when I need greater access to internal sculpture. However, even then the incision ranges about 2 cm about 0.8 inch. Unless the areola is tiny this is much smaller than an incision extending half way around the areola. I reserve longer incisions for revising other surgeons' scars such as Revision Gynecomastia Surgery moving poorly placed longer incisions to edge of areola.

Skin Reduction Chest Lift Donut Mastopexy takes a certain surgical skill and technique that not all surgeons have. I rarely need such methods for a typical gynecomastia patient. Here is a Large Areola Complication from another surgeon's Bad Donut Mastopexy that I revised. I have seen quite a few similar examples.

When there is a good deal of Excess Male Chest Skin, then I prefer a Skin Reduction Chest Lift that does not put skin tension on the nipple areola complex and does not need the buried permanent suture to keep the areola diameter reasonable. This does involve an incision around the entire areola and a second incision in the crease under the chest muscles. But then that is a compromise patients need to consider when they have so much extra skin on their chest after major weight loss.

Checking actual before / after surgery examples of a recommended technique is a better way to see what a surgeon is recommending.

Hope this helps,

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