American Society of Plastic Surgeons
For Medical Professionals
2 years ago

What exactly is going on with my chest?

I got gynecomastia surgery back in mid November 2021 and while I’m very happy with the results, I’m worried about the appearance of my areola/nipples. When I raise my arms up, they both cave in a little bit. When I flex, they both kinda fold into each other. When I do nothing, they look decently normal, though I wish my areola wasn’t so large but that’s another issue. Should I be concerned?

Procedure: Male Breast Reduction
Location: Downingtown, PA

Replies 3

Debra Johnson
ASPS Surgeon

Gynecomastia surgery involves removal of the tissue between the areola and the pectoral muscle. Post-operatively, scar tissue develops that can connect between the muscle and the skin. So when you flex the muscle or raise your arms, the scar pulls on the skin causing the indentation. Massaging the area can stretch the scar tissue and reduce the tethering. Sometimes releasing the scar from the undersurface of the areola and then grafting some fat there can lessen the pulling and reduce the skin folding. You should discuss this with your surgeon.

Elliot Jacobs
ASPS Surgeon

You have mild crater deformities which is due to too much removal of tissue below the areolas. There is now a lack of support of the areolar skin. The areolar skin is not scarred, tethered or attached to the underlying muscle -- it moves when you push or pull the areolas No amount of massage, exercise, etc will improve this. The best way to improve your situation is to discuss revision with your surgeon. I have revised many cases similar to yours and have found the use of subcutaneous fat flaps to be a superior, one and done approach to the problem. Fat grafts may need to be repeated in order to achieve a similar improvement. Elliot Jacobs, MD, FACS

Karthik Ramasamy
ASPS Int. Surgeon

You seem to have a mild crater deformity and some adherent tissue which is causing the folds in the nipple. Massages in that area can help loosen the attachment, exercising and bulking your muscles little can improve the shape too. if not working in these ways then a release of the scar tissue maybe under local anaesthesia with fat fill if necessary, may be needed


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