Nipple reduction?

[TacoTuesday]

Hey doctors, my nipples are fairly flat when not hard, but tend to become quite knobby-looking (significantly more than my friends) when they become hard. Is there a way to fix this? Just to be sure, I'm talking about the nipple, not gynecomastia. Thanks!

[Dr. Elliot Jacobs]

Try posting some good quality close-up photos of the nipples in both the flat and erect positions.

Dr Jacobs

[DrBermant]

Hey doctors, my nipples are fairly flat when not hard, but tend to become quite knobby-looking (significantly more than my friends) when they become hard. Is there a way to fix this? Just to be sure, I'm talking about the nipple, not gynecomastia. Thanks!

There is a thin muscle under and in the areola that flattens puffy nipples for most men. There are some men that have flat nipple areola region when this muscle is relaxed. On stimulation, this muscle for these individuals, pushes the nipple out further making it look strange. This is a normal function for this part of anatomy for giving a baby something to latch onto. For breast feeding this is fine, for men, not great for contouring.

Male Nipple Reduction works for men with long nipples. When used on a male who has flat nipples when relaxed, and extended when stimulated, this surgery can result in small craters when relaxed. To demonstrate this condition use the images on the last page showing close ups of the nipple from front, left and right obliques, and side views. Each view should be done with areola muscle relaxed and then repeated when stimulated to demonstrate the nature of this problem.

If a doctor says they have a surgical solution for this problem, check for actual before and after pictures of results for this particular deformity. Unfortunately, I have seen too many such attempts by other doctors.

This issue can exist by itself or coupled with other aspects of gynecomastia such as Puffy Nipples. When other elements exist, surgical options for sculpture can be an option.

Hope this helps,

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

[TacoTuesday]

I think my problem is little bumps near the base of the nipple which create a protruding base for the nipple to sit on when the areola hardens. Maybe those little sections can be removed?

Hopefully there's something I can get done. Are the results usually natural-looking for nipple reductions?

Here are some pics for your viewing pleasure.

Soft nips album: http://s1200.photobucket.com/albums/bb323/TacoTuesday1/Relaxed%20nips/

Hard nips album: http://s1200.photobucket.com/albums/bb323/TacoTuesday1/Hard%20nips/

[Dr. Elliot Jacobs]

Thanks for the photos.  It looks as though you have  reasonably sized nipples when soft but long or protuberant nipples when hard.  It is difficult to see the "bumps" you are talking about in these photos -- one would really need an ultra-macro close-up to see them.

In general, however, I think you might be best served with a nipple reduction -- done carefully so as not to remove too much.  There is probably not much that can be done with bumps near the base of the nipple (as you describe).  Best to consult an expert in gyne surgery for this surgery.

Dr Jacobs

[TacoTuesday]

Thanks for the reply, Dr. Jacobs.

Dr. Bermant, you said a nipple reduction in a case like mine can result in small craters. From my pics, do you agree with Dr. Jacobs that a nipple reduction would serve me well?

Are scars for this procedure invisible? The pics on Dr. Bermant's page are too far away to see any nipple scars, and healing doesn't look complete yet.

[Dr. Elliot Jacobs]

The technique that I use for nipple reduction requires a few, thin, dissolving sutures on the outside.  Once healed, the scars are virtually invisible.

Dr Jacobs

[DrBermant]

Dr. Bermant, you said a nipple reduction in a case like mine can result in small craters. From my pics, do you agree with Dr. Jacobs that a nipple reduction would serve me well?

Are scars for this procedure invisible? The pics on Dr. Bermant's page are too far away to see any nipple scars, and healing doesn't look complete yet.

If you are happy with the nipple length when unstimulated, nipple reduction is not the answer unless you want to risk a crater or something that looks like an inverted nipple deformity that I have seen from other doctors' attempts at treating this particular variation. That is why you should investigate stimulated / relaxed before and stimulated / relaxed after pictures from a surgeon who claims this is a viable solution for a nipple that is too long when stimulated but fine when relaxed.  Reduce something that is normal and you can get less than normal. Reduction still does not solve the underlying issue of the nipple getting longer when stimulated.  That is why I do not post an example of that solution on my website, I do not think it works for that problem alone. It can work when there are other elements of concern.

So if surgery is an option for you depends on the actual nipple length and other factors best determined after learning more information during a consultation or a Remote Discussion.

Long Nipples in Men can be made shorter. A nipple length of 2 mm is normal. Longer can push out a shirt. However, there is nothing wrong with much longer nipple length. My reduction for just the anatomic nipple is typically done under local anesthesia alone. In picking a surgeon, make sure you can see before / after surgery examples.

Here is a rare case of Big Nipple Gynecomastia that had gland in the anatomic nipple itself. This needed more extensive local anesthesia with sedation.

And here is a more typical case of combined behind areola and long nipples that required a 2 stage surgery. The first under local with sedation. The second under local to reduce the anatomic longer nipple done about 6 days later or longer.

My technique varies based on the problem to be treated. But even in the anatomic nipple reduction involves several layers of different types of dissolving sutures. Scars hide nicely, check the many different nipple suture scars on my site to see the evolution for this particular part of the anatomy.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

[TacoTuesday]

Thank you for the reply, Dr. Bermant.

Dr. Jacobs, do you have any before/afters for a case like mine? Or do any other doctors have before/afters?

[Dr. Elliot Jacobs]

If you send me your email in a PM, I will send you photos of typical results of nipple reduction.  I am having technical difficulties posting images directly on this reply.

Dr Jacobs

[Miguel Delgado MD]

The nipple is a dynamic organ and difficult to control. It sounds very reactive and this is normal for you. I would let it be and forget about it.