Author Topic: Gynecomastia Experiences - Unhappy After Surgery in - Are Nipple Backwards?  (Read 7505 times)

Offline DrBermant

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Dear Dr Bermant,

Around a week ago I had a corrective operation to remove addition gland/fatty hard tissue (as they called it) which had not been taken out and although I am now satisfied with my shape which is much flatter (Although I am sure there is still room for improvement for me in the future), another problem has now arisen.

My nipples now look completely different, I almost have the impression that they have been reattached back to front, yet the Polish doctor I am in contact with keeps telling me this is impossible as their surgical procedures make it impossible (this is the same doctor that after the first operation told me "my breast on the right side was still a little large because that's how some men are" - a ridiculous statement I thought at the time. The problem is however they will not give me a reason as to why it is impossible, as they removed both nipples entirely in the operation, and I simply don't trust what they say after the hassle had I had to go through after the first operation in order to get a corrective operation done. One thing is for sure however, I will never go back to -- for a cosmetic op that isn't just liposuction because from my experience the outcome is never as they say it will be, that and the hospital food is terrible.

The reason I think they may be back to front is firstly there are tiny red patches of veins about 3/4 cm in width stretching across from the nipple to the edge of the areola on both sides. This is definitely not dried blood or anything like that and secondly the areola have become unusually puffy and the nipple is barely sticking out at all, whereas before I had quite perky nipples even after my first Gynecomastia operation and lastly they feel completely different, much softer and spongier.. I can send you some pictures of the nipples also if you wish.

Having never seen the other side of a nipple I would really appreciate it if you could tell me is it similar to the outside at all and would you get these little red veins showing like I have described?

I am going to see my doctor on Tuesday morning, but the advice of an independent plastic surgeon like yourself would be invaluable to me and I would be very grateful.

Kind regards,

Unless the nipple areola is removed for a graft and re-attached, it is nearly impossible for the surgeon to put the tissue on backwards. When the nipple areola are isolated on nearby tissues as a flap, the interval healing can look strange. When the blood supply to tissues is compromised, veins can become more prominent.

Skin Reduction Gynecomastia Surgery is a significant compromise for scars. It becomes a powerful tool when skin is a major component of the deformity as in Male Mastopexy Surgery. The surgery requires a exit point for the skin.

When such methods are used for normal gynecomastia, the results are disfiguring and, in my opinion, totally unnecessary. Surgical judgement comes from experience. Each surgeon has his / her own skills. Unfortunately, you are not the first asking for my advice after going somewhere to "save money" or without carefully evaluating a surgeons specific skills with male chest contouring, revision surgery, or how that tissues evolve with a technique.

Understanding those skills before considering surgery is critical. Surgeons' websites are valuable tools to understand just what that particular doctor offers.  I have added new resources on How To Pick a Gynecomastia Surgeon and How to Evaluate Gynecomastia Pictures. If loose skin was a factor then you should have been looking at my Standard Pictures for Male Mastopexy and Loose Skin of the Male Chest.

Unfortunately, most surgeons do not demonstrate what tissues look like between the problem and the results. It is my opinion that those with less refined techniques prefer to hide how their method works. I certainly would be frightened if one of my patients looked like your images. I probably might have a different opinion about letting the public see such images. However, my practice philosophy has been different. I want a better recovery, less swelling, and bruising. I have used such images to better refine my methods such that Healing, Swelling, Bruising After Skin Reduction Male Mastopexy are typical for my patients who needs the tissue on a flap.

Scars often evolve over time, yet, why assume any patient will end up with invisible scars. Although that may happen, it is unrealistic to assume that will happen.

On the male chest, scars look horrible when extending from the areola. That is why I prefer to hide the scars around the areola and under the shadow of the pectoral muscle and chest junction. These are natural body features and tend to fool the eye as to their existence. Something extending from the middle of the areola just looks surgical. In my opinion if a surgeon is going to use that method, a patient should be shown typical scars from that option.

Why not consider posting the standard before surgery pictures, especially the views bending over to demonstrate if there were any loose skin issues. If none were taken, why not post a complete standard set of what you have now? It can help others better understand your concerns and better weight their options about who to select for surgery.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction
« Last Edit: June 15, 2011, 01:45:51 AM by DrBermant »
Michael Bermant, MD
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Offline DrBermant

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I do appreciate your help on this. To the best of my knowledge both nipples were surgically removed completely and then reattached, don't know why it was done this way but I am pretty sure it was and I can't understand it really.

Nor do I, nipple removal and a long scar about the areola makes no sense if a flap was not involved. Perhaps the surgeon can advise you. I have never in all of the many years I have been doing this, never removed a male nipple and then reattached it (and I have done an amazing amount of male chest sculpture. The few times I did offer that surgery to a female patient, there were no other options and that procedure was known by that patient before considering the surgery. Even then, I never had a patient look like the images you showed me.

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I am interested in what you say about male mastopexy not being the right method. Just how would you have done this differently if you had done the operation. I had severe Gynecomastia to begin with and after this op I still have a little loose skin left even after this mastopexy although i'm hoping the skin will tighten up after a few months. How would you have done this without me have lots of loose skin remaining?

On a forum post, I can discuss general issues and general concepts. I can not offer specific advice on a forum, that would be establishing a doctor patient relationship without the necessary information.  When I offer my opinion about what I would do or would have done, I first review the original problem, doctor's office notes, operative reports, and forms that our patients fill out to learn more before offering specific comments or advice.

A little loose skin is usually a much better trade off than unsightly scars. At least a surgeon should not blind side a patient with something they had no idea would be happening. That is a principle I worked on throughout my career. My goal was to have my patients tell me that their results were close to or better than what they saw on my website. Such images should be available for a patient to see typical results before surgery. That is a rule of the major Plastic Surgeon Societies of the United States. Doctors are required to show patients typical results, not their best ones, but ones representing what a patient can realistically achieve from the surgery.

Male Mastopexy is indicated for patients with a great deal of loose skin. Scars should be better camouflaged. Problems for which this surgery is appropriate are demonstrated with typical results on my site. If done on someone with less loose skin, then an educated patient before surgery should be able to choose the option of leaving the loose skin and avoiding the scars. Beyond that, patients are better served if they can see evolution images showing what healing looks like with that method. Here is another similar Recovery After Skin Reduction Chest Lift on Transgender Male to Female to Male where loose skin was too excessive to leave behind.

It is all a matter of patient education and establishing realistic expectations. Were you shown before and after pictures for problems like your chest? Do your results look like what you were shown?

You are welcome to post images here yourself if you want others to better understand your concerns and perhaps avoid falling into the same situation or at least have the same emotional stress you have expressed.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia of Male Chest Ptosis - Sagging and Male Mastopexy Chest Lift Sculpture
Michael Bermant, MD
Retired Plastic Surgeon
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