6 month post op, nipples still puffy & the same shape & size - could things change from now? (Photo)

During gynaecomastia surgery it is very common to perform both liposuction of any fat within the breast followed by resection of underlying breast tissue. It is of the utmost importance that a cuff of fat is preserved directly underneath the nipple-areolar complex (the dark circle surrounding the nipple) so that it remains viable.If you are unhappy with your results, it is always best to make an appointment with your original surgeon so that you can undergo re-examination and have the opportunity to discuss your concerns.

Dear Gregarious278738,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

It takes about 12 to 18 months for the healing process to complete. During this time there will be excessive scar tissue which will eventually regress. Also, please bear in mind that a small amount of breast tissue has been left behind as padding to support your nipple and prevent it from sinking. My advice would be to see your surgeon and discuss

To make a quality assessment on the outcome of a plastic surgery procedure we have to see quality or proper before and after pictures. If you don’t have before and after pictures then ask the surgeon to forward the ones they took.
There are three variables that can create fullness on a male chest.
Being so excess glandular breast tissue or true gynecomastia, access subcutaneous fat and skin laxity.
Each one is treated differently and a good assessment needs to address all three to see which one or which ones are creating most of the problem. skin laxity tends to be an issue in individuals who have had significant weight fluctuations or in older men.
One way to identify glandular tissue is to put the skin and pectoralis muscle under tension. take one arm at a time and stretch it behind your head. while doing this you can see and feel the exact contour of the soft tissues especially if there is residual glandular tissue. With one arm at a time stretched behind your head you can either look in the mirror and palpate or use the timer on your camera and take pictures.
With the skin under tension it also gives you a good way to assess the thickness of the subcutaneous fat layer. It should be very thin with the skin being stretched almost looking and dented like it’s been over treated. as you slowly move your arm down to a resting position you’ll see the fullness on your chest develop and the goal is then to try to figure out if it’s skin laxity that’s bulging if it’s due to fat or if you need more glandular tissue taken out.
It would be helpful to know exactly what you had done in your first procedure. Typically plastic surgeons who do these procedures well do a combination of liposuction with open excision of glandular tissue.
We always leave some glandular tissue because that’s normal and taking all the glandular tissue out will leave someone with an indentation which is irreparable.
Sometimes revisions are needed and it’s certainly better to be on the conservative side and leave some glandular tissue then to take out too much. over resection of glandular tissue leads to a deformity that is almost impossible to correct later.
If the condition was brought on by supplements or inappropriate testosterone use then individuals should stop the stimulating agent in order for the breast tissue growth to not continue.
Follow up with your provider and if he or she does not give you the answers you’re looking for and this still bothers you enough to have surgery again then consider a formal second opinion consultation with another provider.
For a second opinion consultations I recommend people come prepared with copies of their before and after pictures as well as a copy of your previous operative report. These are all part of your medical records and available to you if you ask your previous doctors office to forward them to you.
Best,
Mats Hagstrom MD