Puffy Nipples: to Excise the Gland or Not Excise the Gland? (photo)

27 in Massachusetts. i have a very mild form of gynecomastia (localized to nipples only). my nipples are soft and pillow like in appearance and to the touch. i have read surgeons saying that lipo is enough to treat mild gynecomastia, but others say no; that the glad has to be excised, and i also read that if to much is removed then you are left with an inverted nipple. so i am just wondering what the right approach is for someone with a mild case of gynecomastia.

Doctor Answers 5

Resection vs lipo for puffy nipples

The exam is critical to tell if direct excision is needed vs lipo. In experienced hands of a board certified plastic surgeon, an inverted nipple would not be a common event. If the tissue is firm than direct excision is best.

Puffy nipples can be reduced by removing extra breast tissue directly below the areola and nipple. It is often done under local anesthesia as an office procedure. Addtional breast tissue fullness outside of the nipple area is usally removed with liposuction. Exercise will not help this condition. Cost depends on experience of the surgeon, location of the surgery, surgical time, and type of anesthesia used.

Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Excision probably better

It really depends on if there is excess fatty tissue. If yes, then liposuction can help. If there is excess skin/glandular tissue, then excision would be necessary. Only a physical assessment would determine the right one for you.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

Puffy Nipples Can Easily Be Removed

Generally the tissue just beneath the nipple and areola is dense and is not able to be suctioned out well. I prefer to remove it through a small incision at the edge of the areola by a combination of avulsion and excision. It is not likely to cause inversion of your nipples.

William H. Huffaker, MD
Saint Louis Plastic Surgeon
4.9 out of 5 stars 49 reviews

Puffy Nipples and Gynecomastia

In minimal gynecomastia, where the problem is limited solely to prominence or puffiness immediately beneath the nipple, simple direct excision probably is the best option.  The tissue in this area is usually dense glandular tissue and is difficult to remove with liposuction alone.  Even liposuction that has an added energy source - ultrasound (VASERLIPO) or laser (SMARTLIPO) - may not adequately remove this dense tissue.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.8 out of 5 stars 56 reviews

“Puffy Nipples" Best Treatment?

Thank you for the question and pictures.

The best treatment for localized glandular tissue causing “puffy nipples” is direct excision;  whether this operation will be indicated in your case depends on how much the prominence bothers you in comparison to how much an incision below the areola (resulting from surgery) will bother you.  If the prominence caused by breast tissue, not adipose tissue, liposuction alone will likely not be effective.

Only you will be able to determine whether the trade-off of a scar is worth the improvement in contour.  For example, will the presence of a scar below the areola prevent you from removing your shirt?

If you do decide to proceed with surgery make sure you have the procedure done by a well experienced board-certified plastic surgeon.

Best wishes.


Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

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.