Hi PaulColpitts, Thank you for your question about what to do with your dark purple and black nipple 48 hours after your gynecomastia surgery. Based on your single picture and without a physical examination or history of the gynecomastia surgery performed, your question is difficult to answer in a forum like RealSelf. There are many different ways to treat gynecomastia including traditional liposuction,VASER liposuction, radio-frequency, male breast gland removal, areolar reduction, and formal male breast reduction. Each gynecomastia procedure has its own inherent risks complications. Nonetheless, it is very important you follow up with your plastic surgeon immediately. There is no time to wait. Your picture is very worrisome. Your nipple maybe dying. If this is venous congestion and the life of the nipple is threatened, there are some topical medications which can help to decrease the dark purple areas. However, these medications must be initiated immediately. Please do not wait. Please call your plastic surgeon now. I hope that I answered your questions regarding your discolored dark after gynecomastia surgery. Also, I hope that I have stressed the importance of following up with your plastic surgeon. If you have any other questions regarding gynecomastia or male breast reduction, please contact my office. Sincerely, Dr. Katzen.