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Blog. Top 3 Reasons for Post-op Puffy Nipples

We give time regularly to help guys online because we know that, for some, gynecomastia is a significant obstacle to feeling confident and content with their lives. Whether in a web-based forum or in the consultation room, man boob sufferers have our sympathy. Given 35+ years of pioneering and perfecting male breast reduction, we truly care about guys with this issue whether they choose surgery or not.

Men who do proceed with gynecomastia surgery and are dissatisfied afterward suffer additional torture. Many travel a long road prior to their procedure, having dealt with teasing and bullying, “remedies” that don’t work, social isolation and more. To have the courage to step up for surgery and have hopes dashed–we understand the pain. That’s why we try to help guys who need expert advice online both pre- and post-op.

One question we field often is about persistent puffy nipples. Here are the top three reasons guys may suffer with puffy nipples after male breast reduction:

1) Their cosmetic surgeon performed liposuction only.

We find that nearly all our patients with man boobs need both liposuction and gland excision. In fact, even if the only breast problem a guy has is puffy nipples, with no other excess tissue, the tissue behind the nipple will be breast gland that needs to be excised. It can’t be suctioned away. Some cosmetic surgeons seem convinced that lipo only can work for many guys with enlarged breasts–we don’t see it that way. That’s why we developed our own instruments that can remove both kinds of tissue (gland and fat) with gentle cutting and suctioning as needed.

2) Their doctor was overly conservative.

It takes experience with many patients for a plastic surgeon to feel confident re-sculpting a guy’s chest. Creating natural looking, smooth results is not as easy as it may seem, and it’s impossible to know exactly what challenges a procedure may pose until the operating team is “in there.” A surgeon with limited gynecomastia experience may not know that the nipple and areola must lie flush with the surrounding skin immediately following surgery. If not, not enough tissue has been removed. (If the nipple is indented, then too much tissue has been eliminated.)

Sometimes, surgeons without much gynecomastia experience may be concerned about inadvertently creating a problem like the dreaded crater deformity, and may therefore not remove enough tissue. Hence, puffy nipples may persist.

3) Scar tissue may have formed.

When we advise post-op patients with puffy nipples, we suggest they consider the time line of their recovery. If their chest looked pretty good during the initial recovery period, then nubby tissue began to form under the nipples later on, it’s quite possible that scar tissue is the culprit. If this is the case, it’s likely the cosmetic surgeon’s skill had nothing to do with the problem since scar tissue is somewhat unpredictable. The good news is that in many cases scar tissue can be tamed with injections or even minor surgical repair.

We responded to a post on recently from a guy who was unhappy with his appearance after recovery–the nipples in particular–and was suggesting other guys with moobs avoid surgery. It’s heartbreaking to hear from a man whose experience has been so difficult, but we would like to assure other guys considering surgery for man boobs that it is more than possible to achieve a good outcome. When a patient chooses a board certified plastic surgeon with significant experience with moobs and follows instructions carefully, there’s every reason to look forward to a physique that’s at least “much better” than before surgery.

The same goes for revision gynecomastia surgery too. We meet many revision candidates unhappy with their results with another cosmetic surgeon, and it’s true that occasionally we can’t help. But that’s the exception rather than the rule. Most times we can say with confidence that we can improve a guy’s outcome provided he has realistic expectations.
If you’re struggling with man boobs, we invite you to send us an email. We’re interested in hearing from all kinds of guys with gynecomastia, and we’ll help if we can.


Dr. Elliot William Jacobs is a board-certified aesthetic plastic surgeon who specializes in FTM top surgery, gynecomastia surgery, revision gynecomastia surgery and male breast reduction. He is a native of New York and has over 40 years of experience in his field. Dr. Jacobs is a highly respected and sought-after surgeon who is known for his skill, experience, and compassion. Whether you are interested in gynecomastia for the first time, or are looking to correct a gynecomastia you aren’t happy with, Dr. Jacobs can deliver amazing results.


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