had surgery, revision and a kenalog shot - little bit puffy and pointy HELP! me

[cowboy100]

Ok so heres the deal,

I had my actual surgery about 3 years ago, went back for a revision (over a year ago) and the one side was still a bit puffy so I had a kenalog shot on my left side(4 months ago). Currently both nipples are a tiny bit puffy mainly the left side that I got the shot on which I can more easily feel scar tissue underneath my skin if I rub it around. Another visible issue for me is my nipples are suppper sensitive, they go from soft to hard by small temperature changes and even just movement. They are also fairly protruding when hard which is probably what I hate the most. I still even now message them fairly often. I am wondering if anyone has any similar experience and tips for me. Should I bother to still message them or care this do more harm. My doctor said when I came the third time there was no need for surgery and I requested the kenalog shot...but I feel like its worse after the shot. Would it still be healing after this long. Can anything else be slowing or making it worse...I do drink a lot. I also looked into having my nipples actually reduced so they are not protruding, there are doctors who do this generally for woman, has anyone had this done or got protruding nipples because of surgery, messaging or whatever caused it. If I'm not running around and just lying on my back my chest looks fine but they are so sensitive and gravity also doesn't seem to help. TIPS, THOUGHTS please? also if I do message is it better to do it hard or softly...I tend to push a bit   

[DrBermant]

Ok so heres the deal,

I had my actual surgery about 3 years ago, went back for a revision (over a year ago) and the one side was still a bit puffy so I had a kenalog shot on my left side(4 months ago). Currently both nipples are a tiny bit puffy mainly the left side that I got the shot on which I can more easily feel scar tissue underneath my skin if I rub it around. Another visible issue for me is my nipples are suppper sensitive, they go from soft to hard by small temperature changes and even just movement. They are also fairly protruding when hard which is probably what I hate the most. I still even now message them fairly often. I am wondering if anyone has any similar experience and tips for me. Should I bother to still message them or care this do more harm. My doctor said when I came the third time there was no need for surgery and I requested the kenalog shot...but I feel like its worse after the shot. Would it still be healing after this long. Can anything else be slowing or making it worse...I do drink a lot. I also looked into having my nipples actually reduced so they are not protruding, there are doctors who do this generally for woman, has anyone had this done or got protruding nipples because of surgery, messaging or whatever caused it. If I'm not running around and just lying on my back my chest looks fine but they are so sensitive and gravity also doesn't seem to help. TIPS, THOUGHTS please? also if I do message is it better to do it hard or softly...I tend to push a bit   

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

Areola reduction surgery is sometimes needed in men, but you need an access place for the skin to be removed. Large Areola Reduction Surgery is a significant compromise that I rarely recommend unless there is a great deal of excess skin (such as After Massive Weight Loss or in large breast Transgender Female to Male Chest Contouring.) There are many techniques to tighten the skin and remove areola, each has their own compromises.  However, flat nipples hanging well below the pectoral muscles look much worse than scars from reduction.  For major amounts of excess skin, a Skin Reduction Chest Lift may be an option.  Depending on sutures to hold areola tissues at a smaller size is a real risk as seen in the example below where I revised a mess from Australia surgeon's use of dissolvable sutures.  Permanent sutures can break, stretch, and get infected.  Such risks are better explored during a consultation after an evaluation.

Warning Graphing During Gynecomastia Areola Reduction Surgery Pictures

You can see actual pictures during a  Revision Donut Mastopexy Areola Reduction Surgery here. 

Photographs during surgery to reduce big areola continue here. and there are more Pictures during surgery to reduce male areola here.

The areola usually expands with bigger breasts.  Like a balloon, with deflation (surgery) there is a reduction in diameter. However, a balloon can deflate and the diameter not change. Check out the second and third photo sets in that gallery link to see what I mean. One of the causes of failure of shrinkage can be a layer of remaining gland after gynecomastia surgery.  Roll your cursor over that text or image and you can see a drawing of gland that can be left behind after surgery.  I have seen many examples of gland adherent to the muscle areola complex that keeps the areola puffy and larger diameter.  That is why I prefer to target the gland first with my Dynamic Technique for Gynecomastia.

Check out the many before after pictures of this  Areola / Nipple Reduction Gallery, Areola Reduction Picture Gallery, and Pictures of Areola Reduced with Gynecomastia Surgery.  These results are typical for my sculpture of my patients.

For other men, the thin muscle under the areola nipple makes the nipple protrude instead of Flattening Puffy Nipples When Stimulated. When the contour under the nipple is not a factor, stopping this type of protrusion is not something surgery helps. 

Surgery can contour remaining tissues causing Puffy Nipples After Gynecomastia Surgery.
Firm tissues after surgery can be residual gland, but also can just be healing tissues or scars.  Different surgical techniques injure tissues to different degrees.  The body typically needs to heal before considering revision surgery. Rushing into secondary surgery can be a mistake unless there are complications that need to be addressed or the next surgery is component of a staged procedure.  Time to tissues softening can vary depending on the original problem, what was done, after surgery care,
Scar Care, After Surgery Compression Garments, and many other factors. Options depend on the problem to be treated. Time can range from 6 months to a year but can vary depending on many issues best explored with your doctor.

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. 

Hope this helps,

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

[Dr. Elliot Jacobs]

There are normal physiologic changes in the nipples and areolas which occur when the ambient temperature changes or in response to emotional changes.  The nipples harden and enlarge and the areolas tighten and wrinkle up a bit.  These are all normal and cannot be changed by surgery, injection, etc.

If your nipples are too large or protruding, then they can be reduced to a more normal size.  This is a quick and relatively simple surgical procedure often performed under local anesthesia.

If you still have puffy nipples after surgery, revision and kenalog, you should be evaluated by an experienced gyne surgeon to see if anything more can be done. It is possible that something more can be done to help you -- and possibly nothing more can be done.

Dr Jacobs

[cowboy100]

well the a protruding a bit when relaxed but mainly just when I exercise or there is a temperature change, and mainly on the left side. I figure if I get them reduced right down they will be flatter when cold etc, and pretty normal when relaxed. But I am worried about the side effects and cost. If in Canada is it not covered, or if I go to the same doctor who did my gyno surgery would he do it for free because it could be a side effect from the surgery???

[Dr. Elliot Jacobs]

Nothing lost in simply asking your original surgeon.

Dr Jacobs

[cowboy100]

Which I do plan on doing very soon, but I am still wondering on things like messaging and such. I can feel lots of scar tissue moving around when I run my left side but nothing really on the right, both nipples are supper sensitive and would likely benefit from nipple reduction surgery but I would like to know side effects on that as well like will the end of my nipple be discolored or anything of that nature and what are the costs???
 

[Dr. Elliot Jacobs]

Massage may help within several months after surgery -- but at your position (one year after revision), I doubt if it would be very helpful.  On the other hand, nothing lost in trying.

If your nipples (not the areolas) are excessively large, either in their diameter or in their height or protrusion from the chest wall, appropriate surgery can be done to improve either or both.

Speak to your surgeon about that or perhaps consider speaking to one of the surgeons who contribute to this forum.

Dr Jacobs

[DrBermant]

well the a protruding a bit when relaxed but mainly just when I exercise or there is a temperature change, and mainly on the left side. I figure if I get them reduced right down they will be flatter when cold etc, and pretty normal when relaxed. But I am worried about the side effects and cost. If in Canada is it not covered, or if I go to the same doctor who did my gyno surgery would he do it for free because it could be a side effect from the surgery???

There is a thin muscle just under the skin that when stimulated can Flatten Puffy Nipples. When this muscle relaxes, subtle deformity reveals itself only to be hidden after stimulation. The options of if a revision is covered under the prior surgery is something that needs to be directed to your surgeon.

Which I do plan on doing very soon, but I am still wondering on things like messaging and such. I can feel lots of scar tissue moving around when I run my left side but nothing really on the right, both nipples are supper sensitive and would likely benefit from nipple reduction surgery but I would like to know side effects on that as well like will the end of my nipple be discolored or anything of that nature and what are the costs???

Scar Care at one year after surgery often has little effect. But this depends on many factors best directed to your surgeon.

Risks, benefits, and alternate methods of care for any revision surgery are best explored after understanding the original problem, what was done, the current problem(s), medical history of any particular patient during an evaluation and consultation. Cost of Gynecomastia Surgery Revision can vary widely in my office depending on many factors, the cost can also vary from surgeon to surgeon and around the world.

Hope this helps,

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

[gy1]

well the a protruding a bit when relaxed but mainly just when I exercise or there is a temperature change, and mainly on the left side. I figure if I get them reduced right down they will be flatter when cold etc, and pretty normal when relaxed. But I am worried about the side effects and cost. If in Canada is it not covered, or if I go to the same doctor who did my gyno surgery would he do it for free because it could be a side effect from the surgery???

Hey Cowboy100.  i'm having what sounds like the same problem as you.  I am going to go back to see my ps.  I am 8 months post op and my nipples protrude so much that i cannot wear a tshirt.  it is even visible through a shirt and sweater.  This problem is worse than my original problem.  i am hoping my ps can help, but i am doubtful, as i don't know what he could possibly do.  my whole areola gets hard and seems detached from my chest.  i can pop my nipples in and out of my chest.  i am actually furious and extremely depressed over this.  i will let you know what my ps says.  let's stay positive.

[cowboy100]

ok keep me posted, I would say for me this is less of a problem then the original but as soon as my nipple go hard which is very often then they protrude and are very visible through a t-shirt. I may consider getting another shot on the left side but for sure I want to get the protruding nipple reduced or basically "cut down" so that even if the sensitivity is not fixable they look pretty normal when hard. I am also wondering the cost of nipple reduction NOT revision or gyno surgery because I have had both and know those costs. I would have to assume on average its a lot cheaper cause it is quick, requires no lipo and little to no med's. I will be talking to my doctor this summer but I'm literally at the point were I want to cut the ends off my self cause other summer of avoiding taking my shirt of is just insane.