Your Questions

Q: Dr. Eppley, I have gynecomastia reduction but my puffy nipples persist which was the problem in the first place. My surgery was in October 2012 and it was liposuction via the armpit area. I am a 31 year-old in good shape and this has been a problem in my life since I can remember. I can’t tell you how excited I was to have the surgery FINALLY after all these years. The end result, however, was a leaner chest (one side a little more than the other) and still puffy nipples. When I read some of your comments online I figured I’d look for a second opinion, as my first surgeon has offered a second surgery to correct my problem.

A: Your result does not surprise me with that approach. While liposuction can make the chest leaner, it will not in and of itself take away the puffy nipple. That is going to require an open areolar incision to directly remove the firm breast tissue that lies right under the nipple. This tissue is just too firm and gritty in many cases to be removed by liposuction. If there is one thing I have learned about the puffy nipple in young males is that they want it completely flat and that is only going to be most assuredly achieved by direct areolar excision. The liposuction is helpful for general chest contouring but rarely removes the puffy nipple.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I’m a skinny guy with puffy areolar tissue. I’ve had it my entire life. It is not steroid induced. Considering surgery, I am a student covered under Anthem Blue Shield insurance. I am not sure if it will be covered. I hunch my posture to conceal the protrusion in shirts, and it has lead to a lot of neck and back pain. I do not have a picture of it, but my build and areolar shape look exactly like the case study on your website for gynecomastia reduction for athletes/body builders.

A: The amount of gynecomastia the patient to which you refer had is the most type that I see. It is a harder type of gynecomastia that causes the puffy nipple appearance due to its mass effect. The amount of breast tissue present is much more significant that it looks on the outside. It must be removed through an open approach using a lower areolar incision. This smaller type of gynecomastia is not covered by insurance in my experience and is considered a cosmetic procedure. The overall cost of an open gynecomastia reduction procedure done under general anesthesia taking one and a half hours of operative time is in the range of $4500 to $5000.

Dr. Barry Eppley

Indianapolis, Indiana