Q: Dr. Eppley, I had gynecomastia reduction surgery two years ago. Breast tissue was removed through incisions on the underhalf side of the areola. No liposuction was done. The incisions healed well and, while it looks a lot better than it was, my nipples are still a bit puffy. My doctor said it was swelling for several months after surgery but it never got better. I want my nipples completely flat with no puffiness at all. I don’t want to see them poking out through a shirt. I can not feel any hard lumps under the nipples so I think it is just fat. The puffiness has a soft feel to it. It pushes in easily. I am thinking this residual fat may be able to be gotten rid of by exercise or losing some weight. Do you think this will work?
A: Gynecomastia surgery, when done through an open resection of glandular breast tissue, is an art form in terms of how much tissue to remove. There is no precise method during surgery, when the patient is laying horizontal on the operating room table, to determine if the nipples will lay completely flat afterwards. The one thing a plastic surgeon wants to avoid is over-resection or removing too much breast tissue. This will create a crater deformity after surgery. To avoid this problem, surgeons will be more conservative rather than aggressive in tissue removal. This means that in some cases after surgery that most of the nipple protrusion is gone but it does not lay completely flat. This is due to residual breast tissue or incomplete resection not fat. This can only be improved by secondary gynecomastia reduction surgery to remove more breast tissue. It will not respond to any method of fat burning or weight loss.