Gynecomastia Crater/Nipple Sinking-in. Is This Edema? What Could This Be? (photo)

Question

5 wk ago I had gyno surgery lipo & gland removal. 1.5 wk ago I noticed right in the middle of my nipples & areolas that my nipples were sinking & the craters has appeared to get a little larger, but not to the extent that the entire areolas are sunken in. Lower chest is tender to touch as well as tight when arms raised. My doctor believes that this is edema. He advised massaging the areas. Is it possible for swelling to cause this appearance & will it subside w/o needing correction?

S. Larry Schlesinger, MD, FACS · Answer

The other Real Self responders to your question have given you some great answers.  Unfortunately, only time will tell.  It is very possible that there is swelling around the nipple and scar tissue at the base of the nipple pulling it down.  Once the swelling (edema) resolves, you will have a better picture of what is going on. 

	At this point, I would wear a compression garment day and night with some Reston foam inside to add extra pressure, and possibly even an ace wrap to squeeze out all residual edema.  In my practice, we use therapeutic ultrasound (the kind physical therapists use for sore muscles) which converts sound energy into heat bringing blood supply to the area and carrying away swelling and some nonviable cells.  With a little luck, your surgeon did a perfect job and the edema and scar tissue are giving you the picture you see right now.  Pressure, ultrasound, and some judicious injections of Corticosteroid at the base of the nipple may fix everything, but if it does not, corrective surgery is relatively simple, quick and uncomplicated.

John Nguyen, MD, FACS · Answer

It is too early to assess the outcome of the surgery.  In my experience, this tends to resolve or improve with time.  Good luck and be safe.John T.
Nguyen, MD, FACS, FICSDouble Board
Certified Plastic Surgeon

Ronald Schuster, MD · Answer

It may simply be some early scar tissue drawing the area inward. Definitely massage. if it gets real tight a steroid injection might help. Keep in touch with your surgeon.

Babak Dadvand, MD · Answer

Hi dust72,Thanks for the post and the photo. It is not unusual to have some fluctuation in the shape of the chest during the first month or two after surgery. The reason for the nipples and areolae "sinking" is not due to edema. If anything the edema would have been the greatest earlier on after surgery and gradually decrease the farther out from surgery. The cause is either over-resetion or scar tethering. If it is the latter then massage may help. If it is the former, then you will likely need a revision procedure to add volume. However at 5 weeks it is too early to determine that. I recommend you stay in communication with your surgeon.Sincerely,Dr. Dadvand

Mordcai Blau, MD · Answer

It is not a common occurence but if is not subsiding within a few month can be treated using local fat fleps.

Scott Barr, MD · Answer

The single image you have taken shows bilateral inverted nipples. If they were fine at 4 weeks post op and are now inverting, it may be some scar tissue causing retraction. As plastic surgeons we leave some tissue on the back of the areola to prevent nipple and areola depression post operatively. I would continue to massage. It will work by ensuring that the areola and tissue behind it are not adherent to your fascia. If the nipple retracts in and up when you flex your pectoralis, you have adhesions. Heavy massage, occasional injections and close follow up with your surgeon will optimize your results. In the very rare case of over resection of the underlying tissue, a small fat graft will easily correct it. Time will usually resolve this issue if it is scar tissue. Dr. Scott Barr

Darryl J. Blinski, MD · Answer

In my opinion only based on the one posted photo you might have over resection of the N/A area causing the indentation or involution. Best to seek other in person opinions. At 5 weeks I believe it has been long enough to determine that edema is not causing the indentation.

Steven Wallach, MD · Answer

It may very weill be that you are suffering from edema( swelling) in the area, and you should wait it out for several months.

Tom J. Pousti, MD · Answer

Thank you for the question and picture.

	The depression that you are referring to is visible in the picture. However, it is much too early to evaluate the end results of surgery and whether revisionary surgery will be helpful. As difficult as it may be, I suggest continued patience and allow for 3 to 6 months to pass before making an evaluation of the end results of surgery.

	In the meantime, continue to follow up with your plastic surgeon.

	Best wishes.

Raj S. Ambay, MD · Answer

It is likely it is edema. I would wait it out. Your final result may not be evident for 3-4 months.

Gynecomastia Crater/Nipple Sinking-in. Is This Edema? What Could This Be? (photo)

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