Gynecomastia (male breast enlargement) comes in many forms, from a large almost female looking breast to just a scant amount of excessive nipple or areolar projection. In my Indianapolis plastic surgery practice, I have seen more ‘minor’ cases of gynecomastia in the past few years. In these minor expressions of gynecomastia, there is a special subset in which the main aesthetic problem is that of excessive nipple projection.
Excessive nipple projection can occur in the teenage years as well as in the older male as well. The prevalence in the younger teenage and young male patient has a lot to do with cultural influences to which we are exposed today. The current appearance of the male models that are used in advertising show a chest that is both hairless but very smooth including a flat nipple. I call this the ‘Abercrombie Fitch’ look which helps drive a young males perception of attractiveness. As young male are often shirtless given their activities, this look can be very influential. Older male, conversely, are primarily bothered by the protrusion of the nipple that can be seen through shirts.
In many cases, this nipple and areolar protrusion may or may not be part of an underlying mild gynecomastia. Some men merely have hyperactive nipples or more promiment nipples than others. In other cases, there may be a small or areolar gynecomastia that pushes the nipple forward by volume displacement.
Correction of these nipple and areolar protrusions are quite simple and uncomplicated. If the areolar is flat, but the nipple is undesiringly protrusive, a simple nipple reduction can be done. This is done by taking a wedge from the center of the nipple and closing it, making the nipple flat and permanently disrupting its ability to stick out any further. Some nipple sensation will be lost but this is usually irrelevant in a male. If the areola is protrusive, then breast tissue must be taken out from underneath it. Through a semi-circular incision on the bottom part of the areola, the nipple and areola is lifted up and a wedge of tissue is removed. The amount of tissue removed should be sufficient enough that there is a slight indentation at the time of closure.
Both nipple reduction and areolar gynecomastia are simple outpatient procedures that have virtually no recovery and only a short limitation from strenuous activities after. Both heal with virtually no detectable scarring and consistent aesthetic improvement.
Dr. Barry Eppley