Age 25, still have puffy nipples 9 months post-op (fluid in nipple) (Photos)

Question

I had gynecomestia surgey back in august 2021. I still had puffy nipples on both sides. Right side has more. Age 25 this november. I had gynecomestia bcoz of Steriods Done sonography on may. Report says some fluid inside nipple, its been 9 months from surgery now.

Ronald Schuster, MD · Answer

Residual puffy nipples after surgery is due to either residual gland which was not remove, scar tissue, an extremely weak areola or a residual seroma. Sometimes it is very hard to tell from an examination. Steroid injections help scar tissue. Aspiration can help to identify a residual seroma. Sometimes it will take additional surgery to fix it.

Daniel Barrett, MD · Answer

Dear Sayyed saqib,
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

Mats Hagstrom, MD (license on probation) · Answer

To assess the outcome of a surgical procedure we need to see before and after pictures. Knowing where you started can help determine the quality of result.

Different plastic surgeons have different approaches to doing the surgery. Typically doing a combination of liposuction and open excision of breast tissue gives the best results.

Plastic surgeons need to balance getting quality outcomes without over respecting breast tissue.

Over treating leads to irreparable deformation with indentations that can be upsetting and almost impossible to fix.

Sometimes revision procedures are indicated and sometimes they are not.

Variables that limit the potential outcome from this procedure include the severity of preoperative gynecomastia, any type of skin laxity from weight fluctuations and age.

Even mild skin laxity can have a profound negative influence on getting what many people consider ideal outcomes.

You can access the thickness of your soft tissues including breast tissue by putting the pectoralis muscle and chest skin under tension by stretching one arm at a time behind your head while looking in the mirror or having someone take a picture.

With the skin and pectoralis muscle under tension you will see soft tissue contour more exactly then with the arm in a down position which always causes slight bulging and this is where skin laxity can play an important role in understanding what can or cannot be achieved with the procedure.

A fluid buildup after gynecomastia surgery it’s pretty unusual but depending on how the procedure was done it’s possible you have a seroma. Men with more advanced or profound gynecomastia sometimes lactate.  I’m not sure if this could be a milk duct fluid buildup but regardless getting yourself evaluated with an in person evaluation is your best bet.

Your best option is to follow up with the surgeon who did your procedure and ask him or her for an evaluation and assistance.

If that doesn’t work then consider having a proper second opinion consultation.

Consultations should be done in a person and patients should come prepared bringing with them proper before and after pictures and a copy of the operative report which are available from your provider‘s office if you request them.

For assessing the outcome of a surgical procedure always include before and after pictures.

Best,

Mats Hagstrom MD

David E. Berman, MD (retired) · Answer

A puffy nipple-areolar complex (NAC) requires a different procedure (same incision) than what is usually done for gynecomastia, which is when there is generalized breast fullness. I treat a puffy NAC in my office with local anesthetic. I elevate the NAC much thinner than I normally do with regular gynecomastia surgery, and then I excise some of the underlying tissue directly beneath the NAC. no drains are required. Most surgeons do not recognize that a puffy NAC needs a different procedure than routine gynecomastia.

david berman md, frcsc

david berman md, frcsc

Age 25, still have puffy nipples 9 months post-op (fluid in nipple) (Photos)

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