10 Weeks Post Gynocomastia Surgery, Why Are my Nipples Are Hard, Puffy & Slightly Itchy. Gyno Still Noticeable Through T Shirt?

There are three types of surgical #treatment #options available that treat the various levels of gynecomastia. Normal Gynecomastia is usually apparent in boy between the ages of 12 to 15 years old and older men 65 years old or more who experience a drop in their testosterone levels. This type of Gynecomastia takes about one to two years to regress on its own.Pure Glandular Gynecomastia is seen more commonly in body builders and is caused by steroid use. Surgical removal of the gland is required for treatment.Adult Gynecomastia – Fat deposits are apparent in the glandular tissue. This type of gynecomastia is the most common. Doctors may recommend surgery for treatment of the condition.Adolescent Gynecomastia is hereditary and usually appears in 30% to 60% of boys between the ages of nine to fourteen. Many cases of adolescent gynecomastia resolve on its own as the boy grows into adulthood. Some may choose to undergo surgery to correct the situation, this usually happens at the age of 18 or above. In severe cases in young boys, the physician and child development specialists will need to speak to the parents regarding the severity of the gynecomastia and if surgery is an option before the age of 18.Assymetric or Unilateral Gynecomastia appears in either one or both breasts at different degrees. In many cases one breast appears larger than the other. Surgery is a common treatment for this type of gynecomastia.Pseudo-Gynecomastia is composed of adipose tissue instead of glandular tissue. This type of gynecomastia can be treated with diet, liposuction or surgery.Severe Gynecomastia commonly affects those who have lost skin elasticity at an older age and those who have been obese or overweight at one point in their life and lost weight may have saggy skin and breasts that are severely enlarged. Surgery is the recommended treatment for severe gynecomastia. There are three types of surgical treatment options available that treat gynecomastia. The doctor will recommend the one that is best suited to each individual case. Following surgery, your incisions will go through a maturation process. For the first few months they will be red and possibly raised and/or firm. As the scar matures, after 6-12 months, it becomes soft, pale, flat, and much less noticeable. You may experience numbness, tingling, burning, “crawling”, or other peculiar sensations around the surgical area. This is a result of the healing of tiny fibers which are trapped in the incision site. These symptoms will disappear. Some people are prone to keloids, which is an abnormal scar that becomes prominent. If you or a blood relative has a tendency to keloid formation, please inform the doctor.Bruising and #swelling are normal and usually increase slightly after the removal of any tape or foam. The bruising will decrease over 3-4 weeks, but may last as long as 6 weeks. The majority of the swelling will be gone within the first 3-4 weeks. However, it may take 6-9 weeks to disappear completely. Also, as you heal, the area may feel “lumpy” and irregular. This, too, decreases with time, and massaging these areas will help soften the scar tissue. The #compression garment helps reduce the swelling, and the longer it is worn, the more quickly you will #heal. It can also assist in the retraction of the skin. If you have any concerns about #healing, its best to ask questions of your surgeon or their nursing staff.

       There may be residual swelling at this point, and this appearance may change.  Kenneth Hughes, MD Los Angeles, CA

A photograph would be helpful.  Treating gynecomastia with liposuction and tissue removal is appropriate.  The treatment must be aggressive to make sure effective removal and contouring of the chest is accomplished.  Your contour may improve but again it is hard to say without a picture.

Dr. ES

Hi LJ8412,Thanks for the post. There are two possible explanations for your puffy nipples at 10 weeks:1) Residual breast tissue2) Scar tissue formationThe way to differentiate is if the areolae initially appeared flat after surgery then became puffier then it is likely scar tissue formation. If the areolae were puffy right after surgery and have not reduced, then it is likely residual breast tissue. Swelling typically does not feel hard. I recommend following up with your plastic surgeon.Sincerely,Dr. Dadvand

I have performed many of these procedures over the years and found that for some reason even if the gynecomastia tissue is aggressively removed sharply and surgically, there is often residual swelling later. I think this comes from some degree of residual hormonal responsiveness and the tendency for the gland to enlarge. If this occurs, like with you, I treat patients with steroid injection given on three different occasions at least six weeks apart and this cures 95% of patients.

As part of a subcutaneous mastectomy for gynecomastia it is important to leave a 1 cm cuff of breast tissue under the areola otherwise the blood supply to the nipple could be compromised.  It is possible that this is what is causing your puffiness.  Hopefully over the next several months this will improve.  

The residual puffy nipples could be swelling or scar tissue that has formed. You need to give it a full six months after surgery for complete healing. Many times this represents some residual breast tissue right underneath the nipple that may need to excised to get a flatter nipple. Your surgeon has to make an intraoperative judgment as to how much breast tissue to remove under the nipple and does not want to risk the nipple dying or creating a crater deformity (inward nipple inversion) because too much breast tissue was removed.

Nipple sensitivity and swelling is not uncommon after gynecomastia surgery.  I would recommend that you allow things to settle down, don't expose your chest to the sun without diligent application of sun screen and continue to followup with your plastic surgeon.

Hi.

1)  First, wait until four months after surgery to consider a revision.  Things may well improve.

2)  But the treatment of puffy nipples is different from the correction of gynecomastia.  Most men with gynecomastia do not have puffy nipples.  So if, for whatever reason, your puffy nipples were not dealt with at the original surgery, that can be done with a revision.  Hope this is helpful.