Very puffy areolas/nipples post-op (with pictures)

[Timbucktwo]

I got my surgery 4 weeks and 5 days ago for gynecomastia that I've had since puberty that never went away.  I am 26 now.  Post-op I had to wear heavy padding and a compression vest for the first two weeks, lighter padding and compression vest for one more week, and then just a compression vest for about 10 hours a day (or at night when I slept) for one more week.  

So when I was first able to finally have my vest and padding off after one week (only to take a shower) the areolas/nipples were completely flat.  It was when I was no longer wearing padding that my areolas starting to get a little bit puffy.  And now that I am no longer wearing a compression vest my areolas are very puffy (photos attached) like they were before surgery, maybe even more.  They also seem a little bit hard if that helps at all?

I know that one month is not that long at all after surgery but this just has me very worried.  The surgeon told me he did a combination of liposuction/gland removal but I'm starting to doubt that he did the gland removal.  So I guess the question here is, did I get ripped off?  Or do you think my nipples will flatten over time?  

Thank you in advance!

Tim

[Dr. Elliot Jacobs]

At one month, there is lots of healing ahead of you -- so I would not spend too much time in worrying -- it won't alter the situation but it will provide you with premature grey hair!

The fact that the nipples flatten out is a good sign -- if it were scar tissue producing the problem, it would not change overnight.,  Besides, scar tissue takes weeks and weeks to develop -- it doesn't appear quickly.

It is possible that your surgeon did not do a lot of peripheral skin undermining during the surgery.  This is a key step in treatment of puffy nipples.  Simply doing lipo or a small gland excision under the areola will still not allow the skin to retract and tighten in all directions.  One must undermine the skin as well, otherwise the excess areolar skin will have no place to go and it will remain puffy.

Dr Jacobs

[Timbucktwo]

So you don't think it is scar tissue then? I was hoping it was so it would go away later... I can't afford to take any more time off to get a second surgery. Will wearing my compression vest help anymore at this point?
Thanks again,
Tim

[Litlriki]

Scar tissue could cause the nipples to be puffy and give you the sense of hardness under the nipples.  This might respond to a cortisone injection if it's related to the scars. Compression makes things look flat because it controls edema (swelling) and without compression, the tissues fluff back up (rehydrate, essentially). After six weeks, there's little indication that compression helps with healing. 
Is there an incision on your left (?) nipple or is that a crease?

[Timbucktwo]

I attached another photo so you can see it better. The one right under the nipple is just a crease (that was there before surgery). Im not really bothered by the crease but why does that happen?  The other line on the outer edge of the areola is the incision scar.

[Litlriki]

Creases occur naturally and also as a result of surgery in some patients, especially if the areola is significantly distended by the underlying glandular tissue.  Removal of the tissue relieves the "pressure" causing the bulging of the areola, and when it collapses down, sometimes creases occur. In some cases they're temporary, but they may remain long term.  
Your surgeon can decide if Kenalog is appropriate for you based on presentation and timing after your surgery. 

[Dr. Schuster]

I agree with all the other surgeons. One additional thing that might help wold be to massage the skin and stretch your chest out. healing will definitely take time. Hang in there.

[Timbucktwo]

It is now 6 months after surgery and I just wanted to update anyone reading this that my areolas are not as puffy as they were in the photos I have attached. They're still not as small/flat as I'd like but I am hoping with more exercise and healthy eating that I can make them look a little better. Thank you to everyone that had helped me out on this thread!