Nipple Reduction – Patient 104

A man in his late 20’s is troubled by prominent breasts (gynecomastia) as well as prominent nipple papules. This really bothered him at the beach, and also when wearing shirts. As in many of my cases here in Boston, he has had this since puberty. He denies significant marijuana use or anabolic steroids, which have both been known to cause gynecomastia (male breast development). In his case we would list the cause as “idiopathic”, which is a fancy word for “the cause is not known”. As much as 30% of young males can have some breast development at the time of puberty, but in the majority of these men, it resolves spontaneously. If it has not gone away by 18 months, however, it is probably not going to go away without surgery. At first glance, his gynecomastia and nipple prominence may not seem too noticeable, but an oblique (3/4) view and side view tell the story. He is shown before, and again, 6 weeks after a combination of a nipple papule reduction with a “top hat flap”, combined with external ultrasound assisted liposuction of his chest and a direct excision of a small button of breast tissue through an incision around his areola. The keloids in the middle of his chest are preexisting from acne scars, and were treated at the time of his surgery with the injection of Kenalog, a type of steroid that can soften and flatten scars. His tattoos are blurred for his privacy, the photos are otherwise unretouched.