Revision Needed? (4 months post op) *Pics Included*

[jarman65]

     Its been about 4 months since I went under local and had my puffy nipples worked on. The results were an improvement but they still are not perfectly flat. The right nipple is about 3/5 the size it was before and the left nipple is about 1/2 the size it was before. They don't bother me as much when I have my shirt off (I don't usually where a shirt around the house now) but I still feel uncomfortable wearing a t-shirt because my nipples stick out and I still feel a little uncomfortable.

1. What do you guys think of my results 4 months post op?
2. Will they get any flatter with time or should I go back for a revision to remove the rest of the fat or gland?
3. Also will the scarring be any worse than it is now if I end up getting a revision?

Pictures:
http://img40.imageshack.us/i/img0130no.jpg/
http://img40.imageshack.us/i/img0131dkb.jpg/
http://img18.imageshack.us/i/img0133ae.jpg/
http://img18.imageshack.us/i/img0136tv.jpg/
http://img40.imageshack.us/i/img0137zh.jpg/
http://img40.imageshack.us/i/img0138mx.jpg/
http://img18.imageshack.us/i/img0139id.jpg/
http://img38.imageshack.us/i/img0141pg.jpg/

[DrBermant]

     Its been about 4 months since I went under local and had my puffy nipples worked on. The results were an improvement but they still are not perfectly flat. The right nipple is about 3/5 the size it was before and the left nipple is about 1/2 the size it was before. They don't bother me as much when I have my shirt off (I don't usually where a shirt around the house now) but I still feel uncomfortable wearing a t-shirt because my nipples stick out and I still feel a little uncomfortable.

1. What do you guys think of my results 4 months post op?
2. Will they get any flatter with time or should I go back for a revision to remove the rest of the fat or gland?
3. Also will the scarring be any worse than it is now if I end up getting a revision?

Pictures:
http://img40.imageshack.us/i/img0130no.jpg/
http://img40.imageshack.us/i/img0131dkb.jpg/
http://img18.imageshack.us/i/img0133ae.jpg/
http://img18.imageshack.us/i/img0136tv.jpg/
http://img40.imageshack.us/i/img0137zh.jpg/
http://img40.imageshack.us/i/img0138mx.jpg/
http://img18.imageshack.us/i/img0139id.jpg/
http://img38.imageshack.us/i/img0141pg.jpg/

I see many patients unhappy with Residual Puffy Nipples After Gynecomastia Surgery by other doctors.  The degree of deformity can vary.  Some doctors prefer to depend on gland left behind to prevent Crater Deformity Defects.  Such remaining gland can leave a contour deformity that looks worse especially with animation.  Gland and scar tissues just do not compress like fat, move like fat, and feel like fat.  That is why I evolved my Dynamic Technique to target the gland first and Fat Flaps to permit more gland removal and still have a good contour after surgery.

Typically tissues need to better heal before considering revision options and that can take 6 months or longer.

Hope this helps,

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

[glandular]

I think there could be more glandular tissue to remove. Gland tissue will not go away like fat can. A revision op always opens up the possibility of new scar tissue formation. Even then, your current scars look a lot better than mine and I'm at seven months post-op, so I say give revision a shot.

[gyneuser]

In my opinion your chest is a non-issue. You need to get over the psychological part of thinking you have an ab-normal chest and not worry about it. 

[DrBermant]

Here is another patient unhappy with Residual Puffy Nipples After Gynecomastia Surgery by another doctor.  Check out the  movies before and after this revision surgery and listen to the patient describe his experiences.

Hope this helps,

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

[rayray416]

I am exactly in the same boat as you, but my surgeon wants to remove part of my nipple as he says this is the problem.  My right side has always been the worse of the two and continues to be that, but I am hoping following this revision I will have some good news to express. 

[DrBermant]

I am exactly in the same boat as you, but my surgeon wants to remove part of my nipple as he says this is the problem.  My right side has always been the worse of the two and continues to be that, but I am hoping following this revision I will have some good news to express. 

How tissues move is even more critical in repeat surgery. Revision gynecomastia surgery is an art form. Removing anatomic nipple will not correct for a deformity that originates from behind the nipple. Check many before / after revision surgery photos / movies before permitting a surgeon to perform potentially difficult revision gynecomastia surgery.

Hope this helps,

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

[rayray416]

My surgeon did an excision and lipo, but my nipple size did not change all that much and he feels that making the actual nipple smaller will correct the issue of them sticking out too far.  When cold, my nipples can stick out pretty far, so I am hoping this will help. 

[DrBermant]

My surgeon did an excision and lipo, but my nipple size did not change all that much and he feels that making the actual nipple smaller will correct the issue of them sticking out too far.  When cold, my nipples can stick out pretty far, so I am hoping this will help. 

Some male nipples protrude further with stimulation. This is typically not fixed by surgery. A reduction for the stimulated state can leave a depression when the nipple is relaxed. Again, look for actual photographic examples for proof that a technique works by that doctor before having surgery. Both the before and after surgery pictures should have views of the nipple areola muscles relaxed and stimulated and relaxed to demonstrate the problem and solution. That particular defect that I have seen from other doctors' misadventures has no decent revision options that I have been able to figure out. The onus of proof is on the doctor advocating such intervention that it works!

Hope this helps,

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