How Can I Fix My Puffy Areolas After Prior Gynecomastia Reduction Surgery?
Q: Dr. Eppley, my areolar were not puffy right after gynecomastia reduction surgery, but I did notice my areolas did shrink and my nipples seemed to be a lot bigger than normal. So I had a nipple reduction and then after the nipple reduction I noticed irregularities around the areola where it’s not flat. What would be the procedure to get this fixed? My plastic surgeon is telling me to open the areola again to remove scar tissue. What method will you use? How do I ensure that my areolar will be flat and it won’t look awful when nipple and areola is erect. It looks okay when it’s not hard but when my nipples are hard the areolar and nipples are shriveled into one. How would you fix this?
A: What the areola looks like right after surgery is very deceiving as the swelling can make it look flat, only to appear puffy months later. It is an artistic judgment as to how much breast tissue to remove in an open areolar excision and most surgeons are understandably going to err on the more conservative side to avoid the dreaded crater deformity. Thus when it occurs further tissue reduction is needed through an open areolar approach.
Any type of gynecomastia surgery is done in the static situation not a dynamic one (i.e., the patient is laying flat and the nipple-areolar complex is non-erect.) No surgeon can completely predict what the effects of a static surgery are in a dynamic setting. But it is fair to predict that it will be better when more tissue is removed secondarily.
Dr. Barry Eppley