Puffy nipples 5 months post op...is this normal?

[EastCounty]

Just about 5 months ago I had liposuction and some breast tissue removal done. As far as I can tell, the doctor did a great job; there is no scar tissue, the incision site under each areola is virtually non-existent and there is certainly no crater deformity. The only problem is that I still have an issue with puffy nipples, and it isn't all the time. Strangely, it comes and goes throughout the day.

Normally when I wake up, everything looks great. The areolas are perfectly round and my chest is flat. Once I start moving, and certainly when I put on a shirt, it's as if things warm up and the nipple areas become puffy and pointy again. The roundness of the areola becomes oval-shaped and slants downward (I am sure you all know what I am talking about) and it looks much like it did pre-op, but on a smaller scale. But, at other points throughout the day, the puffiness goes down only to return again. It usually seems to be at its worst at the end of the day and into the night before bedtime.

To my eyes, my chest looks perfectly acceptable when the nipples are not puffed and oval shaped. However, when that puffiness starts up, it's quite upsetting.

IS THIS NORMAL? If not, what does this indicate?

In other words, I understand 5 months post-op is by no means the end of the recovery period. I have read that it can be 6 months to a year before the final result is seen. If I have some time yet before things settle down, of course I can wait. But in the meantime I would like some feedback, especially from the resident surgeons, on this matter. Also, if any of the forum users have had similar experiences, I'd greatly appreciate this comments, too.

I am soon going to schedule a follow-up with my surgeon but I wanted to know what others had to say before I get his take. Thanks in advance.

[gynoforlife]

No this is not normal.
The reason you have pointy nips is because the doctor did not bother to remove the tissue that is attached to the underneath side of the nipple and or beneath the nipple.  Your doctor will probably give you the scar tissue excuse but the only scar tissue should be present is around where the incision was made.  I have observed people on this board for about 10 years and this happens all the time.  I have pointy nips too and you will not find a doctor on planet earth that will fix the pointy nipple problem.  If there is one I would go to him/her.  In addition do not let them chop off you nipple like a lot of docs like to do when the real issue is beneath the skin.  Welcome to the club of pointy nips I am sorry I know the amount of stress is still significant for you.  The problem is the doctors will not remove the tissue from the underneath side of the nipple because they are afraid that the nipple will not have enough blood supply and die.  I personally believe it will not die but I am not a doctor.  The problem with most docs that specialize in this surgery is they do not understand the full boundaries of what can and cannot be done so they bs most of the patients around until they get frustrated and go to someone else.  Kennelog injections does long temporary shrink the tissues and appears to melt away the so called "scar tissue" but its just temporary and not healthy for the body, when the real issue is the tissue underneath.  Please let me know if you find a doctor that is willing to go into uncharted territory with gynecomastia surgery because I need my pointy nipple fix too!

[gynoforlife]

No this is not normal.
The reason you have pointy nips is because the doctor did not bother to remove the tissue that is attached to the underneath side of the nipple and or beneath the nipple.  Your doctor will probably give you the scar tissue excuse but the only scar tissue should be present is around where the incision was made.  I have observed people on this board for about 10 years and this happens all the time.  I have pointy nips too and you will not find a doctor on planet earth that will fix the pointy nipple problem.  If there is one I would go to him/her.  In addition do not let them chop off you nipple like a lot of docs like to do when the real issue is beneath the skin.  Welcome to the club of pointy nips I am sorry I know the amount of stress is still significant for you.  The problem is the doctors will not remove the tissue from the underneath side of the nipple because they are afraid that the nipple will not have enough blood supply and die.  I personally believe it will not die but I am not a doctor.  The problem with most docs that specialize in this surgery is they do not understand the full boundaries of what can and cannot be done so they bs most of the patients around until they get frustrated and go to someone else.  Kennelog injections does long temporary shrink the tissues and appears to melt away the so called "scar tissue" but its just temporary and not healthy for the body, when the real issue is the tissue underneath.  Please let me know if you find a doctor that is willing to go into uncharted territory with gynecomastia surgery because I need my pointy nipple fix too!

[EastCounty]

Thank you for the reply, but I would really like to get a physician's take on this issue.

And by the way, my doctor has an excellent reputation and I do not feel that he would try to deceive me in any way. Regardless, I think it's valuable to draw on as much individual experience as possible, thus I am also asking the forum about this.

[Gammy]

Don't listen to the above post. 5 months is only half way through healing. It prob is scar tissue and/or swelling. Don't let 1 person scare you into thinking that you're screwed for life! Wait for more opinions

[EastCounty]

It prob is scar tissue and/or swelling. Wait for more opinions

I figured as much and reading other posts on this forum, I gather this is probably normal. It's interesting to me that it takes so long to heal at 100%, but I guess it is an exceedingly invasive procedure, so the body needs the time.

Again, when the areola is not "irritated" and round, my chest looks amazing, couldn't be happier. Everything looks natural. But it's when I get moving around is when that swelling happens. Does anyone know what the mechanism is here? In other words, why does it swell and what is causing it to swell. Why does it go up and down throughout the day? Could it even be some residual fluid coming and going?

[EastCounty]

I have my follow-up appointment scheduled for Tuesday. I spoke with the nurse on the phone and she suspects it is probably residual fluid coming and going which is, according to her, common. She said it can be 6 months or more before the fluids stop. Anyone else have a comment about this?

[gynoforlife]

Just want to reply to your posts and give you some other angles to look at this whole situation.  First squeeze both of your breasts and nipple and if you hear a "squishing sound" you have fluid build up in the tissue.  If you dont you most likely dont have fluid build up in the tissue.  From my second surgery I did have fluid build up in the tissues which the doctor drained by injecting a 21 gauge needle deep into the area just above the outer most layer of the chest muscle and pulled out about 10 cc or ml amount of blood from each breast.  After he pulled the blood out of my chest this changed my contour significantly.  I asked my doc at the time if he did not pull the fluid out what would happen and he said the body would absorb the fluid over about 2 months maximum.  With that said you are at about 5 months so you should not have fluid build up at this point unless you are hurting the tissues somehow.  If you want to check it own your own buy a new box of 21 gauge sterile needles (blood will not flow thru 22,23,25 gauge etc), clean the nipple area with rubbing alcohol, insert and see what you get.  You can also probe around to feel what the doc left behind.  If you do probe around this will cause bleeding in the area which will puff your nipple out even more for about 3 days depending how hard and long you poke around.  My point is the body heals at a pretty fast rate and once the trauma stops the tissues began to rapidly heal.  The nipple will go back to normal after a short amount of time.  One thing to note is you can do this over and over and not develop any significant amount of "scar tissue" to change the contour of your nipple breast area.  The bottom line is you can bruise the tissues repeatedly and this "DOES NOT CREATE SCAR TISSUE" that will affect the contour of your breast nipple shape.  If you dont believe me try it for yourself and see what happens.  After the bleeding goes down your contour will not change.  So from what I just talked about above its sounds to me like your problem of puffy nipple is residual gland and or fat underneath the nipple complex and or attached to the underneath side of the nipple complex.

Keep in mind these are my opinions as to whats going on based on the knowledge of my own 2 surgeries and reading the thousands of posts in the puffy nipple section and revision section of this website.

[EastCounty]

Thank you for the reply.

I am not going to administer a needle to myself to try to drain fluids. I simply would not know what I am doing and I am far too prudent to attempt such a thing. If fluid removal is what's needed, I can have my doctor do it.

Anyhow, I am seeing my doctor on Tuesday and we'll take it from there. Since I am at about 5 months, it seems like, whatever it is, it will still need some time to heal. I hear it can be up to 6 months or even a year, depending on who you talk to, for things settle down to where they are going to be. I can be patient and, if any revision is needed, I have no doubts that my doctor will work with me on this.

Reading the posts on these forums, ironically, makes things very confusing. (It's ironic because this site is supposed to inform, not confuse!)

[McGilli]

I think part of the reason that this site can be confusing - is simply that everyone's bodies heal differently. And they all behave differently in some way after things have been scraped or sucked out them. So - while there are people on this forum with the exact same issue as you - their results are different - so you need to see your surgeon.

The only thing I can say is that inserting needles into you and poking around to see if any blood or fluid comes out is really, the craziest thing I have ever seen anyone suggest on this forum. It's very reckless to even consider that. Not saying it's not doable - but it's very risky.

I've had my chest aspirated using needles by a surgeon, and it's just not that easy - not to mention not using any xylocane or local anesthetic around to first inject yourself with.

Good luck!

[Dr. Elliot Jacobs]

I read the posts from gyneforlife and could not disagree more!

First, never stick a needle into your own chest looking for fluid, blood or anything else. This should only be performed, if at all, by a physician who is knowledgeable about sterile technique.  Otherwise, you would risk doing harm to yourself, inducing an infection etc.  Second, at five months post op, having "fluid" is just about impossible.

Next, scar tissue can build up under the skin, under the areola and not just at/under the incision.  Gyneforlife is just plain flat-out dead wrong on this!  Also, when and if scar tissue builds up under the areolaa, kenalog injections are useful and work permanently -- they are not temporary fixes.

Finally, every surgeon's techniques are different.  When I am faced with puffy nipples, I remove virtually all of the sub-areolar breast tissue -- leaving only the thin skin of the nipple -- in every case.  It is safe, the blood supply is totally adequate and it is a permanent solution for puffy nipples.

Dr Jacobs

[EastCounty]

Thank you for the reply, Dr. Jacobs.

Actually, I am noting the the puffiness issue is getting better. My chest appears to be "refining," for lack of a better word. Actually, I would say that most of the time it looks good, especially in the morning or if I am relaxed. In fact, it looks perfect when it's at it's best. It's usually later in the day where it looks puffy and somewhat pointy, but I've noted it's not as bad as it used to be.

So, I guess at nearly 6 months, things are headed in the right direction, at least that's what it seems.

The area under my nipple is not hard and I have never felt any hardness (or a gland) under my nipple, even before I had the procedure. When I raise my arms and I feel my nipple areas, it is flat and it does not feel like there is much tissue there at all. I wonder how much tissue the doctor left. I will ask him.

I am curious, Doctor...what is the reason/mechanism for the tissue to swell at this stage? In other words, why does everything look great in the morning or in periods of low activity? Why does it swell later in the day, and what is causing it to swell? And why does healing take so many months?

Anyhow, I see my doctor this coming Tuesday and I will report back on what he says.

[EastCounty]

By the way, here are some photos I just snapped of my chest. My nipples are only slightly swollen here. When the areolas are more round, chest looks practically perfect. When it gets more swollen than this, and it does, it does not look very good. The nipples get that "tent" look.

Again, this is me at about 5 or 5.5 months. I am 34, 6 feet and 170 lbs. I used to work out pretty regularly (never once did steroids) and I started going back tho the gym this week. I need to trim down and I am hoping that, if I focus on my chest, that will augment the result.

How does this look?

Also, I want to stress that, when things do swell, the tissue underneath is soft, not at all hard, rubbery or fibrous. Because it is soft, that makes me think it could be a little residual fat? (But fat doesn't swell up and down throughout the day, does it?) Am I correct to assume that it is not breast tissue or scar tissue because it is so soft? There is absolutely nothing hard or round under my nipple.

[Dr. Elliot Jacobs]

Your chest looks absolutely fine in these photos.

You have to realize that sometimes puffy nipples are due to a natural physiological process.  It all goes to anatomy.

There are numerous tiny muscle fibers contained within and just beneath the areolar skin.  When stimulated by cold, touch or emotion, these fibers contract.  The contraction is evidenced by the small ridges of the areolar skin that are produced.  As a result, the areola gets slightly smaller in diameter and it flattens as well.  On the other hand, when the muscle fibers relax, the areolar skin smooths out and the nipples can appear puffy.

This is a normal function and there is no surgery or other treatment that can do anything about this.  If, however, your nipples are extremely puffy, then one has to look for some excess tissue beneath which could possibly be removed. And by the way, feeling for the extra tissue is a fool's errand -- you cannot diagnose it this way.  Sometimes breast tissue feels soft and fat tissue feels hard and vice versa.

Dr Jacobs

[EastCounty]

Your chest looks absolutely fine in these photos.

You have to realize that sometimes puffy nipples are due to a natural physiological process.  It all goes to anatomy.

There are numerous tiny muscle fibers contained within and just beneath the areolar skin.  When stimulated by cold, touch or emotion, these fibers contract.  The contraction is evidenced by the small ridges of the areolar skin that are produced.  As a result, the areola gets slightly smaller in diameter and it flattens as well.  On the other hand, when the muscle fibers relax, the areolar skin smooths out and the nipples can appear puffy.

This is a normal function and there is no surgery or other treatment that can do anything about this.  If, however, your nipples are extremely puffy, then one has to look for some excess tissue beneath which could possibly be removed. And by the way, feeling for the extra tissue is a fool's errand -- you cannot diagnose it this way.  Sometimes breast tissue feels soft and fat tissue feels hard and vice versa.

Dr Jacobs

Thank you for your expert insight, Dr. Jacobs!

That is very interesting about the muscles under the areolar tissue. After a few searches online, I could not find any information about this.

Anyhow, as I have mentioned a few times, I am following up with my surgeon on Tuesday, we will see what he says. In the meantime, I am glad to know that you think my chest looks good when those areolar muscles are contracted...I think it looks fine too. Funny, isn't it: when they are tense, I am relaxed. When they are relaxed, I get tense!