Gynecomastia crater deformity. Nipple stuck to muscle or too much gland removal? (Photo)

Question

Hello, I had gland/lipo removal 2 years ago. When I raise my arm the nipple goes in a bit. When I tense my muscle I get a horizontal line and the nipple folds in. The first 6 months I did not have this issue. I have been back to my surgeon who has said its just the muscle tightening everything in the area and nothing can be done. If he puts fat behind it the fat will die and anything else would cause me to have puffy nipples again. Would a piercing fix this if nothing can be done? Thank you

Jed H. Horowitz, MD, FACS · Answer

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. It's possible the indentations can be addressed with cosmetic filler(s) if eligible.

Babak Dadvand, MD · Answer

Hi greenacer,Thanks for the post and the pics. First of all, a piercing will not help because this is not an inverted nipple issue. This is due to over resection and/or tethering.  It is treatable but may require more than one procedure.  Ideally an in person examination is required to determine the best technique but based on the photos you may need scar release and fat grafting. I recommend that you consult with a plastic surgeon experienced in gynecomastia surgery, and specifically revision gynecomastia surgery. Sincerely,Dr. Dadvand

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after gynecomastia corrective surgery.
One of the potential risks associated with gynecomastia surgery is contour deformity related to over resection of glandular tissue and/or adipose tissue.  This is a risk that is explained to patients who are undergoing the procedure. Many patients who have gynecomastia are looking for the chest to be as flat as possible. Surgeons must  balance their desire to achieve the patient's goals with efforts to avoid over resection and contour deformity.
You may find that your situation will be improved upon release of scar tissue in addition to techniques such as fat grafting and use of allograft/dermis as a filler  
I hope this helps.

Steven Wallach, MD · Answer

This is a tough problem to fix and may require multiple procedures.  Release of the scar and fat grafting may be a solution.

John D. Smoot, MD · Answer

Thank you for your question and your problem is both too much tissue was removed and scaring from the nipple to the muscle.  This can be difficult to fix but there is a possible solution. A release of the scar below the nipple and fat grafting may be able to improve this give you an acceptable result.  I don't think that piercing would be of any benefit for you.

David Dellinger, DO, FACOS · Answer

You probably have a combination of a lack of tissue under the nipple plus the nipple retracted and scarred to the muscle. A simple scar release may help, how ever a little fat grafting would be beneficial. I've been referred cases where I was able to transpose some of the underlying tissue in to fill the defect.

G. Peter Fakhre, MD · Answer

This is a difficult problem to correct, however in my opinion you should be able to obtain a significant improvement with a revision procedure.Fortunately your contour irregularity is very focal and localized to the retroareolar area. As such I would recommend a combination of scar release and fat grafting to the area. You may require more than one session but this should improve.Be sure to find a board certified plastic surgeon who performs a significant number of gynecomastia surgeries as well as revisions. Hope this helps and I wish you the best.

Gynecomastia crater deformity. Nipple stuck to muscle or too much gland removal? (Photo)

Answers (7)

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