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Elliot W. Jacobs, MD, FACS - Diplomate, American Board Of Plastic Surgery

Specializing in Primary &
Revision Gynecomastia Surgery

815 Park Avenue New York, NY 10021

Puffy Nipples

The normal male nipple lies flat and flush with the surrounding chest skin. When physically stimulated by touch and/or exposure to cold or by emotions, the nipple becomes firm and protrudes a small amount while the areola actually shrinks a little in diameter. This is the normal physiological response – and the changes are due to the presence of a thin muscle within the areola which contracts and tightens the skin in these situations. The areolar muscle is also the cause of the small ridges on the surface of the areolar skin.

WHAT DO PUFFY NIPPLES LOOK LIKE?

Puffy nipples are different. They actually protrude from the surface of the chest and can have a cone-like or dome-like appearance. The areola (pigmented skin surrounding the nipple) is usually quite wide, due to stretching of the skin. This appearance is always due to the presence of excess breast tissue which is concentrated just below the areola.

Gynecomastia. Puffy Nipples - Before and After Photos - man (left side, oblique view)

When puffy nipples are stimulated, the appearance changes and can look substantially improved. This again is due to the action of the areolar muscle, which contracts and tightens the areolar skin and actually pushes the residual breast tissue down into the breast so that the puffiness seems to disappear. Unfortunately, the effect is temporary – once the areolar muscle relaxes, the puffiness returns.

Puffy nipples may exist alone and are unmistakable on a slender male. But oftentimes they exist on a chest which also has excess fat and breast tissue. Both situations qualify for the term “gynecomastia.”

Gynecomastia. Puffy Nipples - Before and After Photos - man (right side, oblique view)

WHEN DO PUFFY NIPPLES DEVELOP?

In infants, puffy nipples may appear at or just after birth and are due to temporary exposure to the mother’s estrogens. The problem usually diminishes spontaneously. In pubescent boys, puffy nipples (or enlargement of the entire chest) may gradually appear and in many young men, it too will disappear spontaneously. However, if the condition persists for two or more years without signs of improvement, then unfortunately it tends to remain.

HOW CAN TELL IF I HAVE PUFFY NIPPLES?

The diagnosis of puffy nipples is made merely by observation alone. A history of nipple improvement during physical stimulation will further substantiate the diagnosis. It is never possible to feel a nipple and determine if it is puffy, for breast tissue can feel soft and fat tissue can feel firm.

Gynecomastia. Puffy Nipples - Before and After Photos - male (left side, oblique view)

WHAT CAN I DO TO MAKE PUFFY NIPPLES DISAPPEAR?

Surgical removal of the excess breast tissue is the only cure. Many men attempt strict dieting and/or intense exercise – neither works. One can achieve a modicum of improvement by wearing snug compression garments to mask the problem but unfortunately this limits a young man who wishes, for example, to swim shirtless or to play skins-vs-shirts basketball. There are no non-surgical treatments for it, such as pill, hormones, injections, creams, etc.

Some young men try to hide the condition by walking hunched over or by wearing several layers of T-shirts. Again, these methods are limited, particularly in warm weather, and only serve to temporarily hide the condition.

Finally, some men try to use various glues, tapes, Ace wraps, etc to mask the problem. These methods may irritate the skin, cause infections and result in long term pigmentation changes of the surrounding skin. They are not a long-term answer for the problem.

Gynecomastia. Puffy Nipples - Before and After Photos - male (right side, oblique view)

HOW DO SURGEONS TREAT PUFFY NIPPLES?

Surgery for puffy nipples is not simple surgery! It is not a matter of just removing some excess tissue beneath the nipples. If that is all that is done, then it is a good bet that the puffiness will remain after surgery.

Every case is different, but for the most part, virtually all of the excess breast tissue should be removed. If this is the only treatment, however, it would probably result in a depression or crater deformity of the nipples. Proper treatment requires the surgeon to fill in the area where the breast tissue has been removed. This is accomplished with the use of fat flaps, which utilizes adjacent fatty tissue. These fat flaps are surgically dissected from surrounding areas, moved into a position beneath the areola in order to support it and are then sutured in place. Finally, all the surrounding skin must be loosened so that the skin can spontaneously tighten and re-distribute evenly.

If all of these steps are taken, the result should be a flat areola which lies flush with the surrounding chest skin – just like a normal male chest. One additional major benefit is the spontaneous shrinkage of the areolar diameter.

Gynecomastia. Puffy Nipples - Before and After Photos - male (right side view)

I HAVE LARGE BREASTS AND PUFFY NIPPLES – DO I NEED SKIN TIGHTENING AS WELL?

Adolescent males have youth on their side – their skin has an unbelievable amount of elasticity. It is only in the very extreme cases that skin removal is required. In the vast majority of cases, appropriate surgery to remove the tissue (as described above) plus removal of any additional excess chest tissue under the skin will result in amazing spontaneous tightening of the skin. Any surgical skin tightening, no matter what the technique, will result in permanent scars on the chest. The goal of this surgery should be to achieve the very best possible result with the most minimum of scars – otherwise one is trading one problem (puffy nipples) for another (permanent scars). Dr. Jacobs is extremely reluctant to surgically tighten skin at the initial surgery on a young person, preferring to give the body ample opportunity to tighten the skin by itself.

MY AREOLAS ARE TOO LARGE – CAN I JUST HAVE THEM MADE SMALLER?

Some surgeons will attempt to perform a “doughnut” excision of the excess areolar skin. The result is oftentimes a wide, spread out, unattractive scar completely around the edge of the areola. And over time, the areola tends to spread out once again. When this technique is employed, there is very little that can be done surgically to improve the results during a subsequent revision operation.

Dr. Jacobs will perform this procedure only in very limited and specific circumstances.

WHAT ARE TUBEROUS BREASTS?

Tuberous breasts resemble a long, narrow zucchini. They are an extreme form of puffy nipples, in which every bit of breast tissue is concentrated beneath the areolas and the surrounding skin is relatively tight. These are very challenging cases, particularly if excessive surgical scars are to be avoided, but surprising results can be achieved.

WHAT CAN BE DONE FOR VERY LARGE, PROTRUDING NIPPLES?

This situation is not a puffy nipple. Rather, the central nipple itself is too large and protrudes significantly above the surrounding skin. It is particularly embarrassing when wearing tight fitting T-shirts, etc.

The only treatment is a surgical nipple reduction, which can be performed alone or in conjunction with any type of gynecomastia surgery. There are several available surgical techniques to treat this problem – and fortunately the resultant scars are virtually invisible.

Gynecomastia. Puffy Nipples - Before and After Photos - male (left side view)
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