Bilateral mastectomy for gynecomastia; I have complete nipple necrosis on the right breast and a small divot. Options? (Photos)

The nipple has complete necrosis and is now a scar. I know that I will never have a nipple again and I am at peace with that, however I am in moderate pain. It is very sensitive and aches/burns throughout the day. Now for the divot, can there be a lipo injection or get graft in the area so at least I'm more aesthetic?

Doctor Answers 4

How to correct male nipple death (necrosis)?

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Hi Mhermick,

Thanks for your question and photos. I am extremely sorry that you are going through this. This outcome is extremely rare especially in experienced hands. Based on your photos is does not appear like a total mastectomy was done as there still appears to be breast tissue around the area of nipple necrosis. To fix the issue, what I have done for other patients that have presented like you after they were treated by other surgeons is to move the skin around and shift some fat or transfer some fat from the surrounding areas. On the tissue is closed and has a stable base, nipple reconstruction and tattooing is possible to improve the overall appearance.

The pain that you are having could be from the scar tissue trapping nerves or a neuroma or just the slow healing process. I recommend being seen by a board certified plastic surgeon with lots of male breast surgery experience. Good Luck!

All the best,

Carlos Mata MD, MBA, FACS

Board Certified Plastic Surgeon

Scottsdale Plastic Surgeon
5.0 out of 5 stars 38 reviews

Nipple Necrosis on Right Side After Gynecomastia Surgery

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Hello, and thank you for your question. Here are some common post-operative healing issues that can occur with this procedure:

  • Asymmetry during the healing process
  • Lumps or firmness under skin
  • Prolonged swelling (edema)
  • Skin Pigment changes
  • Prolonged redness of the incision
  • Blood clots
  • Hematoma
  • Breast contour or shape irregularities
  • Anesthesia risks
  • Infection
  • Scarring
  • Fluid accumulation
  • Persistent pain
  • Temporary or permanent changes in breast or nipple sensation

And some definitions of these issues:

Contour Abnormalities: Although the doctor will make every effort to give you a “perfect” result, the area of excess tissue removal may end up with a contour that is slightly too high or too low. You may feel the “edge” around the areolar dissection. Massage and time (4-6 months) usually eliminates or reduces this problem, if it occurs.

Reduced sensation of nipple: Any surgery of the breast can lead to reduced nipple sensation. Reduced sensation is usually temporary, but may take months to resolve. In unusual cases, some permanent loss of sensation may occur.

Recurrence of Breast Enlargement: This is uncommon, but can occur. If this happens, you may require further surgery later.

Seroma Formation: A collection of fluid under the skin occurs occasionally during the postoperative period. Aspiration of the fluid with a needle is frequently helpful. Secondary surgery is rarely necessary.

Harness Within Breasts: Postoperative scarring within the breast tissue may cause areas of hardness. Occasionally, areas of hardness, when discovered later may cause worries about cancer. Mammography or even biopsy is occasionally indicated.

Now, one of the best things to remember is that if you find yourself concerned at all about the healing process at any point you should visit your surgeon to have the area examined and make sure that everything is progressing as it should. There can always be complications, but revisions are possible if needed. Best of luck.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Gynecomastia complications

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This is unfortunate but it does happen. I would suggest that you allow things to settle down and let the healing process proceed. Local wound care on the open area will eventually result in its closure. I would start using a Roller device over the chest to help soften things over the coming months as well as hand massage to any areas that are firm. 

Then I would go back and treat the chest so the tissue layer is even and symmetrical which will improve the appearance significantly. A new nipple-areola complex can be "built" by a good surgeon but often this isn't needed as the scar "appears" like a nipple-areola and patients are often comfortable with the result without the need for additional procedures and risk.


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Hello and thank you for your question. I am sorry to hear about your surgical course thus far. To correct the depression it may be possible to break up the scar tissue underneath and do some lipofilling to improve the contour. For the nipple that has died I would consider a tattoo in order to match the color of your native nipple. 

Best Wishes 

Theodore Nyame, MD
Charlotte Physician

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.