Puffy nipples is a subset of gynecomastia, and a term used in my practice to describe lean (and sometimes muscular) men, who present with a lump of tissue concentrated in a mound shape right under the areola, with the areola being pushed up and spread open.
Here are some of my observations on the puffy nipple condition:
It is found in leaner men. Why? Because in larger men, the fat deposits within the gland blend the area surrounding the gland, and causing typical gynecomastia where the whole chest has breast tissue, not just concentrated beneath the gland. Ie, if a lean man suddenly were to gain 30 lbs, his chest appearance would switch from what we term puffy nipple to what we term regular gynecomastia as the tissue becomes a mix of fat and gland.
Typically, material extracted has very little fat. Again, that goes with observation above. I rarely have to do liposuction with puffy nipple procedures. We can go straight to excision, and preservation of any fat is actually important as in those cases, there is no true fat excess and resecting the fat will result in a less smooth contour.
One observation with patients of with puffy nipples is that they get puffier with heat and retract with cold or tactile stimulation. This is because the areola has a thin muscle layer that retracts in cold or stimulation. The retraction pushes back against the gland, and the conditions is not as apparent.
Here is the same patient:
In the first picture, the patient took the picture in the comfort of his hot home.
Note that the muscle of the areola is relaxed, allowing the gland to push out the areola forward and creating a very noticeable excess. It is almost as if the gland wants to push out of the body on its own!
In the second picture, the picture was taken in the preoperative area. The area is cool, and the patient is nervous, both contributing to the areolar muscles being contracted and the puffiness less apparent.
Surgical excision of the gland tissue is the mainstay treatment of the puffy nipples. When the gland is excised, the tissue can no longer push out against the areola, and the mound is flattened.
As with all forms of gynecomastia treatment research, the patients will find a multitude of nonsurgical treatments in via research, but those treatments are of such limited effectiveness or even non effective (think herbal supplements), or have such high side effects (think hormonal treatment) , or fail to address the problem itself (think more diet and exercise) that the patient typically ends up sooner or later finding a surgeon to take care of the issue.
Here is a picture of the puffy nipple being squeezed out of the same patient:
Some patients present to me with puffy nipples even after gynecomastia surgery, and come to me for correction. If they didn’t have proper gland excision, then the puffiness is of course caused by residual gland tissue. Other causes are scar tissue, untreated hematoma or seroma (follow up is important to catch these issues early on), or more rarely, recurrence of gland tissue (most common in patients who use hormone supplements)
If you suffer from puffy nipples, make an appointment with Dr. M.R. Khalifeh, one of the country’s foremost experts in gynecomastia surgery to discuss your treatment options.
No. exercise will improve your overall appearance of course, but will have no direct effect on the gland itself. I always tell my patients, I am not here to compete with diet and exercise, just to address any concerns resistant to diet and exercise. I want all my patients to be as healthy as they can before and after surgery.
In most instances of puffy nipple surgery, we let the areola/nipple retract on its own, without actively cutting away any of the skin/areola. this is to keep the scar as hidden as possible, and relies on the body’s ability to retract. In cases of severe enlargement of the areola where the natural retraction is not possible, we will sometimes actively reduce the areola size via a circumareolar approach/reduction. This technique will leave a more visible scar but is necessary in cases of extreme enlargement. You can learn more about circumareolar techniques by visiting our Circumareolar technique page.
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