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Puffy Nipples: to Excise the Gland or Not Excise the Gland? (photo)

27 in Massachusetts. i have a very mild form of gynecomastia (localized to nipples only). my nipples are soft and pillow like in appearance and to the touch. i have read surgeons saying that lipo is enough to treat mild gynecomastia, but others say no; that the glad has to be excised, and i also read that if to much is removed then you are left with an inverted nipple. so i am just wondering what the right approach is for someone with a mild case of gynecomastia.

Doctor Answers (4)

Excision probably better

To treat a puffy areola, an incision is created that runs around the outside edge of the areola, along its lower half (where the dark areola meets the lighter chest skin). The approach taken depends on the severity of a patient's condition, but for you excision is probably a good option. Dissolvable sutures are placed underneath the skin. These stitches work to both minimize scarring and keep patients from having to undergo suture removal as healing progresses.

The surgery itself is short (only one or two hours) and often requires less than a week for recovery. Large areolae often become smaller after glandular and/or adipose tissue has been removed during the procedure as well. This side effect is the result of the skin covering the chest muscles tightening through the treatment process.

Toronto Plastic Surgeon
5.0 out of 5 stars 62 reviews

Puffy Nipples Can Easily Be Removed


Generally the tissue just beneath the nipple and areola is dense and is not able to be suctioned out well. I prefer to remove it through a small incision at the edge of the areola by a combination of avulsion and excision. It is not likely to cause inversion of your nipples.

William H. Huffaker, MD
Saint Louis Plastic Surgeon
5.0 out of 5 stars 22 reviews

Puffy Nipples and Gynecomastia


In minimal gynecomastia, where the problem is limited solely to prominence or puffiness immediately beneath the nipple, simple direct excision probably is the best option.  The tissue in this area is usually dense glandular tissue and is difficult to remove with liposuction alone.  Even liposuction that has an added energy source - ultrasound (VASERLIPO) or laser (SMARTLIPO) - may not adequately remove this dense tissue.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
5.0 out of 5 stars 17 reviews

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“Puffy Nipples" Best Treatment?


Thank you for the question and pictures.

The best treatment for localized glandular tissue causing “puffy nipples” is direct excision;  whether this operation will be indicated in your case depends on how much the prominence bothers you in comparison to how much an incision below the areola (resulting from surgery) will bother you.  If the prominence caused by breast tissue, not adipose tissue, liposuction alone will likely not be effective.

Only you will be able to determine whether the trade-off of a scar is worth the improvement in contour.  For example, will the presence of a scar below the areola prevent you from removing your shirt?

If you do decide to proceed with surgery make sure you have the procedure done by a well experienced board-certified plastic surgeon.

Best wishes.


Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 750 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.