Puffy Nipples...

[smith1960]

I spoke with a doctor two weeks ago about my gyno which I he says is mild but I do have a pretty bad case of the puffy nipples. I am pretty fit so it's not fat, it's something else.

The doctor said that he will not do an excision but will go in from the armpit area and clean it up a bit with some special liposuction tool which is supposedly able to dig through the breast tissue which is where my puffy nipples are coming from.

I don't have a real bad case of this compared to some other people that I've seen but as someone who has worked out all of my life and who is very fit and conscious of my physical appearance this is something that I could EASILY spend $5000 on to resolve.

Essentially the question here is upon the process described by the doctor. Is there such a special tool? Is anyone familiar with non-excision processes? Do they cure puffy nipples (by far my biggest concern)? Maybe any other information that I should know that I do not know?

I really appreciate it guys! I hate spending $100 just to make an appointment with these doctors and I would love to just get the ball rolling if this scenario does not sound far-fetched or exaggerated.

[jbr]

I would make sure that he's not just talking about regular lipo or even ultrasonic, laser, etc.  Maybe he is referring to a tool (arthroscopic-endoscopic-cartilage-shaver) that some other surgeons use (suck as Levick in the UK, I believe) which actually does cut the gland, but just piece by piece, and accessed through the armpit.  If he thinks the cannula is sharp enough to cut up and suck out dense fibrous gland tissue, I would steer clear, unless he can show you specific successful examples of past patient whose condition was similar to your own.  Having read countless stories on this and other sites relating to poor results when treating gland with liposuction only, I'd be very cautious and do your research.  It seems like that is exactly what you're doing, so that's great.  Best of luck!

[smith1960]

I really appreciate your reply! Because I was not fully confident based on our initial conversation I actually set up a second appointment with him a few days ago for this upcoming Monday. I will be sure to dig deeper into this topic.

[familyman]

I am no dr but everything I found when I was researching this back in January, excision and lipo combination are the only way to get a good result.  I had both done at the end of January.  He only removed 25g of tissue which he said was shaped like an ellipse and then feathered the area for a smooth contour.  I am very happy with the results.  Originally I was hoping to find an easier way so I would not need to do the full anesthesia and surgical thing and keep the cost down.  In the end, I wanted to be sure I would be happy with the result which would cost more money and have a longer recovery time.

[smith1960]

excision and lipo combination are the only way to get a good result. 

And by excision, you mean cutting from the ariella? Using a special tool? Going from the armpit area?

[jbr]

I agree with familyman.  The combination of excision and liposuction definitely seems to be the surest way to the best possible result.  Although, as Dr. Jacobs points out often on these boards, even in cases where the patient is very lean, the lipo is still important because it undermines the skin (separates the skin from the underlying tissue), and allows the skin to re-drape, which helps further flatten the puffy nipples.  Some surgeons go so far as to undermine the skin around the areola with a scalpel or scissors, which seems to accomplish the same goal.  Also, apparently lipo can be done without suction as another method of undermining the skin, without unnecessary fat removal in lean individuals.

My first surgery in October 2013 was excision only, which my surgeon thought would accomplish my goal of flattening my puffy areolas.  He said I probably wouldn't need lipo since I was so lean.  However, he did not undermine the skin at all (nor did he successfully remove nearly enough gland on my left side).  The skin of the areola had nowhere to go, so the puffy look remained.  My second surgery was 9 days ago, and included scalpel excision, skin undermining with scissors, and a small amount of liposuction.  This was done by a much more experienced surgeon than the surgeon who did my first surgery.  It was also much more aggressive and damaging to the tissues, but so  far it looks like the surgery has accomplished my goals.

Regarding you question about what excision means specifically, I would say that it can mean any of the techniques by which tissues are actually cut out from beneath the breast.  This would include either using an incision under the areola to access the tissue or using the "cartilage shaver" tool, accessing the glandular tissue via an armpit incision.  Maybe a doctor can back up my assumption on this definition, and weigh in on whether these techniques are equivalent in terms of what they can accomplish.

[smith1960]

JPR, thanks a ton for the your sharing of experience and knowledge.

How does one determine the experience level of a surgeon? I feel like the ones that I've spoken to are hiding their real experiences (or lack thereof) from me and have not actually done many proper surgeries.

[nipsofpeace]

JPR, thanks a ton for the your sharing of experience and knowledge.

How does one determine the experience level of a surgeon? I feel like the ones that I've spoken to are hiding their real experiences (or lack thereof) from me and have not actually done many proper surgeries.

Ask how many gynecomastia surgeries they do per year. For an experienced surgeon it should be like 150 or more. If they are confident in their abilities they will be proud to tell you the number.

If they try to hide anything, I wouldn't trust them.

[smith1960]

Good to know man! I need to find one of these surgeons that are that experienced. I've only spoken with surgeons that do one or two a month tops. I live near Seattle Washington, what's the best resource to find the best qualified doctor?

[nipsofpeace]

Good to know man! I need to find one of these surgeons that are that experienced. I've only spoken with surgeons that do one or two a month tops. I live near Seattle Washington, what's the best resource to find the best qualified doctor?

Good question, maybe try searching the forum for 'washington' or 'seattle', or Googling 'seattle cosmetic surgeon' and then checking out all the surgeons who pop up.

I checked the surgeon list on this site and there doesn't seem to be anyone listed for Washington https://www.gynecomastia.org/doctor-list-complete

[jbr]

I would say anywhere around 100+ gyne surgeries a year would qualify a surgeon as experienced in gynecomastia reduction.  Granted it also matters how many years we're talking about.  My first surgeon told me he does "one or two a week".  I think that was untrue, or if it was, he must have only been talking about a short amount of time!  What really matters is how much gynecomastia experience the surgeon has in total, and whether they have worked on many patients whose condition is similar to your own.  Take a look at photos on surgeons' websites, and keep in mind that these often are not updated regularly, and they may choose to show examples of only the most favorable results.  If there are only a few photos online, ask if there are more examples they can show you.  If there aren't, you should probably move on to someone else.  If it's necessary to travel to another city or state to work with the right surgeon for you, don't hesitate.  It's a small cost to avoid the huge expense and stress of needing a second surgery.

[jbr]

I think it's also important to note that there may be surgeons who are less experienced in gynecomastia surgeries, who are still good at doing these surgeries.  I wouldn't disqualify a surgeon just because he only has done a few hundred gynecomastia surgeries in total if there is strong evidence that they have had many good results working on patients who looked similar to yourself.  You'll know when you've found the right surgeon, because they will be able to demonstrate their ability and communicate their knowledge about performing these types of surgery.  The key is to be educated yourself, so that you'll recognize this when you see it.

[Dr. Elliot Jacobs]

jbr has made many important points.

I think, more than anything else, the experience of the surgeon in this operation is critical.  It is not easy surgery and getting consistently good results is the hallmark that you should search for.  Sometimes it is worthwhile to seek additional opinions.

Good luck!

Dr Jacobs