Bermant Gynecomastia Male Breast Reduction Plastic Surgery
Male Breast Anatomy of the Gynecomastia Male Chest

Puffy Nipple Complication Deformity After Gynecomastia Surgery.

Why some male breast reductions result in residual contour problems?

Michael Bermant, MD - Retired Plastic Surgeon
Board Certified by the American Board of Plastic Surgery

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Anatomy of Gynecomastia Surgery Puffy Nipple Complication

The Normal Chest Contour should be a continuous curve. Puffy Nipples detract from a male chest contour. Inadequate reduction, residual gland, or scar can contribute to this residual projection. Stimulated Areola Muscle can sometimes lessen the deformity. When skin muscle relaxes, remaining deformity shows again. Scar and gland tend to be firm and not compress like softer fat. Flexing pectoral chest muscles compresses overlying tissues.

liposuction holegland fills holegland compressed by areola muscleAll forms of liposuction (sharp cutting cannula, ultrasonic, power assisted, Vasor, "smart," all preferentially target fat over gland. Liposuction done first digs a hole in the fat leaving gland behind. Remaining gland can result in puffy nipple deformity (compare to Normal Nipple Protrusion). Stimulating thin areola muscle can compress some lesser deformities. However, once this nipple muscle relaxes, the deformity returns. Flexing muscles against firm residual gland, pushes puffy nipples out more.

gland targeted firstbigger gland firstfat flaps developedfat flaps advancedDr. Bermant prefers his Dynamic Technique: targeting gland first. Fat remains behind as a contouring resource to support the nipple. With smaller gland, local fat may be enough for contour. With larger gland, nearby fat can be mobilized as fat flaps and moved to support the nipple. Note the natural contour with muscles relaxed. When gland removed, remaining fat compresses like surrounding fat during animation such as flexing muscles. There is no nipple protrusion thus maintaining a natural look.

puffy nipple deformityflexing muscles pugh out gland furtherflexing muscles compress fatflexing muscles flatten fatHow tissues move during animation such as flexing pectoral muscles is critical for a good result. It is not just looking good in a cold room for a still picture for a journal article. The chest should look good alive while playing sports, with the areola muscle relaxed, when arms elevate, when pectoral muscles flex. Remaining gland does not compress. Flexing muscles forces the gland to puff out further. Fat compresses like surrounding fat. Muscle flexing maintains a male look.

puffy nipple gynecomastia  anatomy Move cursor over links / images to view details & compare techniques. Gland is firm and does not compress like fat. gland fat Fat is soft and compresses like surrounding fat.
Puffy Nipple Surgery Deformity is fat, gland, scar, & skin. anatomy of puffy nipple gynecomastia muscle Muscle when flexed, expands pushing structures on top out further.
Liposuction First targets fat leaving firm tissue & gland behind. liposuction hole dug first small gland first Dynamic Technique targets gland first. Fat remains as resource to support skin.
Deformity partly compressed by stimulating areola muscle. Areola muscle can flatten gland deformity bigger gland first fat flaps developed fat flaps advanced Larger Defect uses Fat Flaps for support
Puffy Nipples worsen when skin muscles relax. puffy nipple deformity flexing muscles flatten fat Gland targeted first, contoured using remaining fat or a fat flap.
Muscle Flexing Gland does not compress and puffy nipples. flexing muscles pugh out gland further flexing muscles compress fat Flexed Muscle Fat compresses like fat a natural contour: no puffy nipples.

Revision Gynecomastia Surgery

Dr. Bermant sees many patients for Revision Gynecomastia Surgery unhappy after other surgeons' male breast reduction complaining that they still have nipples that protrude. Common causes include liposuction alone, leaving gland to support the areola, surgeon inexperience, not taking enough tissue out, too much removed, crater deformities, incorrect assessment of the abnormality, not stabilizing the underlying problem, scars, and residual loose skin deformity. He has just compiled his experience with over 500 patients unhappy after other surgeon's gynecomastia surgery over the past few years. This is an amazing number of dissatisfied people from all over the world.

Misconception that Liposuction Manages Gland of Gynecomastia

Liposuction alone contouring is a common cause. Liposuction is fine for contouring fat. However, liposuction does not remove gland. It can handle soft fat and firm fat, but gland is like the connective tissue under the skin and covering of the chest wall muscles. Any technique that really is effective enough to remove gland will damage the other tissues. Those claiming their techniques deal with gland conveniently seem to discard liposuction aspirate. Dr. Bermant has yet to see real proof that gland was removed. He has seen many patients unhappy with residual deformity after liposuction. Here is one such example of Gland Removed to sculpt puffy nipple deformity after another surgeon's liposuction only surgery. Pictures of gland causing puffy nipples during revision surgery.And here is another patient's Gland removed during Revision Gynecomastia Surgery after failure of liposuction the other surgeon claimed would remove gland. When liposuction is used first, a hole is often dug in the fat to accommodate remaining gland making a "flat" contour.  But the firmer gland does not compress like the surrounding fat causing distortion. In addition, techniques that target the gland remotely need to come at the gland from the gland edges and often leave residual puffy nipples: a layer of gland under the areola that can look bad when the areola muscle relaxes and on animation. Learn more about Revision Gynecomastia After Failed Liposuction By Other Surgeon. Here is another Revision Puffy Nipple Gynecomastia After Failed Liposuction By Other Surgeon.

Fat Flaps Permit Gland Targeted First and Still Support Areola.

Dr. Bermant's Fat Flaps can bring fat into a defect left by targeting gland first.  A flap is tissue moved with a blood supply.  Adjacent fat transferred with a blood supply tends to survive, much better than a graft (tissue moved from elsewhere without a blood supply.)  When carefully done, fat flaps tend to look like normal fat, feel like normal fat, and move like normal fat.  There are limitations to what fat flaps offer since fat still connected to its blood vessels will move only so far. Check out some of the Glands Removed During Gynecomastia Surgery. Click on the links to see the before / after chest contour photos and techniques needed for the sculpture. Fat flaps enabled Dr. Bermant to target such large gland and still support the nipple areola complex.

Gland Needs to Be Left to Support Areola Misconception.

Some surgeon leave gland behind to support the nipple areola and not create a crater deformity. The problem is that this remaining gland does not compress like surrounding fat. Check out this Video of Residual Gland After Gynecomastia Surgery and how this firmer tissue moves.  Watch how the chest then moves when this large chunk of gland / scar is replaced by fat. Learn more about this Revision Gynecomastia After Partial Gland Excision. And here is another example of Revision Gynecomastia After Liposuction and Partial Gland Excision By Other Surgeon.

Large areola diameter and puffy nipple contour often comes from gland distortion of tissues. In some anatomy, the gland is attached not just to the central nipple, but to a wider component of the areola nipple complex. By pealing the gland from the thin under areola muscle, Dr. Bermant has seen some amazing areola size reductions not seen when gland acts like a cast keeping the areola puffy, deformed, and enlarged.

Deformity and Sculpture Look Different from Different Angles & in Motion

Dr. Bermant's sculpture has evolved over the years. He has been carefully documenting his patients with Standard Gynecomastia Pictures. The chest is analyzed from many angles, with arms up over head, and flexing muscles. He then developed Standard Photos to Evaluate Loose Tissues of the Male Torso and Standard Pictures for Chest Revision Surgery. Then to further evaluate how the tissues move, he evolved his Standard Video of the Male Chest.

Although a normal male chest will have a tiny amount of gland, it should not show when the areola muscles relax and when the chest is in motion. A chest should look good beyond just a few still pictures. How it moves when playing sports, exercising, flexing are critical.  It does not take much gland to distort the male chest. Residual gland and scar move like gland and scar, fat moves like fat.

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This page last updated on: January 10, 2013

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