Need experts opinion please.

[winston001]

I am in need of an experts opinion on wether my surgion has took out enough gland or not, i still feel when i look down my nipples protrude from my chest and it bothers me, my surgion said that the nipples should protrude from the chest as thats natural, I had the surgery under the impression after my nipples would be tight against my chest and not stick out at all, i asked before the surgery if they would be flat and my surgion said yes. so i am very confused and wonder if its me being picky, or if he is now telling me what he wants me to hear. I am just over 6 months post-op now.

I've tried to take some decent pictures but its not easy on your own so i hope these are good enough, i notice the problem when looking down at my chest, so thats what I have focused on with the pictures. I hope you can help and thanks for your time.

[Dr. Elliot Jacobs]

Although the photos are not great, I think what you are looking at is the nipple itself, not the areola.  The areolas are virtually flat -- as they should be.  The nipples should protrude a bit -- as they do.

Relax -- these are very good results.

Dr Jacobs

[winston001]

Thanks Dr Jacobs, I think Im just paranoid it's still there or will come back I guess. It does seem better some days than others, not sure if Im imagining it though. I can also feel some scar tissue on the outer sides of my nipples so maybe the area will flatten out more if that goes do you think.

Thank's again for your reply, I feel better now knowing that you feel it's a good result.

[DrBermant]

I am in need of an experts opinion on wether my surgion has took out enough gland or not, i still feel when i look down my nipples protrude from my chest and it bothers me, my surgion said that the nipples should protrude from the chest as thats natural, I had the surgery under the impression after my nipples would be tight against my chest and not stick out at all, i asked before the surgery if they would be flat and my surgion said yes. so i am very confused and wonder if its me being picky, or if he is now telling me what he wants me to hear. I am just over 6 months post-op now.

I've tried to take some decent pictures but its not easy on your own so i hope these are good enough, i notice the problem when looking down at my chest, so thats what I have focused on with the pictures. I hope you can help and thanks for your time.

Sorry your images are not sufficient to evaluate contour issues.

Posting Standard After Gynecomastia Pictures can help other better understand your concerns.

The normal areola chest contour should be a continuous curve with the pectoral muscles, not disrupted by an additional puffy configuration. This contour should persist even on animation. The anatomic nipple can protrude in a normal profile.

I see many patients who complain of residual Puffy Nipple Gynecomastia after another doctor's surgery.  There are many possible problems causing such a deformity.  The most common is remaining gland behind the areola as seen in these Anatomy of Puffy Nipple Drawings.  Check out the images with the link for remaining gland after surgery to see what I mean. 

Even if the doctor achieves a flatter chest, that firm mass does not look like fat, move like fat, or compress like fat.  It just does not move well or look good (especially on animation).  That is why few doctors will show results with chest muscles tightened or arms up over the head or movies showing the tissues in motion.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia Surgery

[winston001]

Just wondered what the male aerola should look like, should it be flat on a man with only the nipple being raised.
I ask this because since my operation last year I still feel when the nipples are warm and not stimulated they look raised from the pectoral area kinda flabby looking. I just expected that after having all the gynecomastia removed the aerola would lie flat against the chest with only the nipple itself being raised. When the nipple is hard the chest appears tighter and more toned looking much like before surgery.

I was told by my surgeon all the gland/Gynecomastia was removed if that's the case why do the aerola's still appear raised when warm, but flatter when stimulated.

So I guess what Im really asking is on a man should the aerola be flat or are all mens aerola's raised slightly.

Hope this makes sense and you can shed some light on the subject for me. I just wonder wether I have unrealistic expectations of how the male chest should look an its more in my head now than anything.

Thanks for your help.

[Dr. Elliot Jacobs]

The ideal male areola should be flat and in a smooth transition from the surrounding skin.  The only protrusion should be the nipple itself.

Dr Jacobs

[DrBermant]

Just wondered what the male aerola should look like, should it be flat on a man with only the nipple being raised.
I ask this because since my operation last year I still feel when the nipples are warm and not stimulated they look raised from the pectoral area kinda flabby looking. I just expected that after having all the gynecomastia removed the aerola would lie flat against the chest with only the nipple itself being raised. When the nipple is hard the chest appears tighter and more toned looking much like before surgery.

I was told by my surgeon all the gland/Gynecomastia was removed if that's the case why do the aerola's still appear raised when warm, but flatter when stimulated.

So I guess what Im really asking is on a man should the aerola be flat or are all mens aerola's raised slightly.

Hope this makes sense and you can shed some light on the subject for me. I just wonder wether I have unrealistic expectations of how the male chest should look an its more in my head now than anything.

Thanks for your help.

The ideal nipple should be a continuation of the contour of the surrounding chest. For a flat chest, the nipple should be flat. When the chest has a pointed shape such as in a fat chest, a flat nipple on a cone shape breast looks frankly bizarre. Flattening the nipple alone in such problems is not a good looking solution, the entire chest contour needs to be addressed.

The shape of the areola also depends on the thin muscle just under it. When stimulated, a residual puffy nipple deformity is hidden. When this muscle is relaxed, a contour problem again shows through.

Another factor that can bring out this deformity is flexing the chest muscles, activity, and at play. A firmer scar, residual gland, or firm fat all can compress differently than surrounding fat.

Check out this post on residual puffy nipple complication deformity that addresses both issues on my web pages:

https://www.gynecomastia.org/smf/index.php?topic=21491.msg145526;topicseen#msg145526

Beyond that there should be no scar step off from surgery.

So the ideal nipple should be a continuation of the contour of the remaining chest both in a relaxed state and when stimulated, both at rest and when active. That is why seeing pictures of the chest relaxed, tense, arms up, from different angles (both oblique and reverse oblique) and close up are so critical in evaluating a contour problem and surgical solution.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737