Q: Dr. Eppley, First of all, I want to thank you for the time that you took and will take to analyze my case, I’ll be eternally grateful for any help that you can provide to me in order to improve my condition.I have been really traumatized over the years for this mistake on a surgery that was made to me when I was 17 years old (I’m 39 years old now) Please see photos attached, I’ll be waiting anxiously your answer.
A: Thank you for sending your pictures. You have a very classic gynecomastia ‘crater’ deformity from over resection of the breast tissue. This has left no intervening tissue between the nipples and the pectoralis muscle fascia, thus allowing the nipple to contract inward and scar down. Its appearance may have gotten a little worse as you have aged because the chest tissue around it (fat) may have gotten bigger allowing the inward nipple retraction look worse.
The correction of nipple retraction after gynecomastia reduction depends on the degree of severity and requires tissue grafting for release and improvement. Your case is fairly severe and you would ideally need an open release and dermal-fat grafts to level out the nipple contours. Dermal-fat grafts do require a harvest site somewhere which is usually done in the lower abdomen. Injectable fat grafting could also be done but that would definitely require multiple treatments to get the best result. There may also be a role for liposuction of the chest around the nipples to help optimize the chest contour also.
Dr. Barry Eppley
Q: Dr. Eppley, I have had gynecomastia surgery performed, but there are areas where liposuction was done that I am very unsatisfied with. I would like to know if there is anything I can do with these areas in regards to slim lipo or laser. I’m not looking for perfection by any means, but currently I feel like the job is half done and am looking for someone to help me finish it.
A: When it comes to dissatisfaction with liposuction, anywhere on the body, the issues primarily revolve around whether adequate reduction was done or that areas of irregularities or indentations exist. While both can be treated, the methods and the success of secondary revision are different. Irregularities pose much greater challenges than inadequate reduction. On the chest, I suspect the liposuction issues are more inadequate reduction. This is because the chest skin and tissues are thick and are less prone to irregularities than other body areas. Further liposuction reduction may be possible. If the issue is persistent areolar fullness or puffiness after liposuction, it may be that you really need open gynecomastia excision to remove the remaining excess breast tissue.
Dr. Barry Eppley
Q: Dr. Eppley, I had gynecomastia surgery one month ago. I have noticed that my nipples are depressed inward. Is this just a temporary look and will it go away and the nipples even out with more time? The tissue directly under my nipple is still hard and stiff. I know I may be panicking but I don’t want it to stay like this.
A: At only one month after surgery, it is too early to say that what you are seeing is the final result. However, a retracted nipple appearance this early after gynecomastia surgery is not a good sign. This indicates that either too much tissue has been removed directly underneath the nipple or the surrounding tissues beyond the nipple have not been adequately feathered to make for a smooth transition into the nipple area. I would much rather see a slightly puffy nipple at this point as all of the swelling from surgery has not yet gone away. Once it does the nipple will likely retract some more. The other reason is that too much residual nipple tissue is an easier problem to treat than when too much is removed. I would wait a full three months and even as long as six months to make your final assessment. This length of time is needed to not only allow the chest tissues to fully heal and relax but because revisional surgery would not be done before this time anyway. If the nipple retraction persists, this is going to fat grafting for correction.
Dr. Barry Eppley