Type 1 Overview

Puffy Nipples


Breast tissue - situated primarily in ~ nipple/areola

Nipple position - in ~ or over pectoralis

Chest wrinkles shape - tight skin, right chest fold through no rounding

Most typical demographic: 15 - 25, teenagers and human body builders

Surgery Information

Anesthesia: Typically performed under neighborhood anesthesia in the office, yet general anesthesia is easily accessible as well.

You are watching: Puffy nipples surgery before and after

Cost: Average price under neighborhood anesthesia is $7,500. Cost will differ if merged w/ other steps or carry out under general anesthesia.

Consultation fee: charged upon scheduling a consultation.

Recovery: 2 days because that sedentary work, 4-6 mainly if project requires heavy labor.

Based on end 2500 gynecomastia surgeries, Dr. Cruise has classified gynecomastia right into 6 various types. Each type is distinctive in its own way must be cure differently. The function of the Cruise classification System is to:

Classify gynecomastia typeDefine patience goalsOutline optimal treatment plan

"A group system is only useful if the outlines a treatment plan."

- Dr. Cruise 


Notice the gradual increase in skin laxity. This overfill skin will adjust the type of surgery important to appropriately correct the problem.


Breast tissue - under nipple/areola only

Nipple position - above border of pec. Muscle

Lateral chest fold - tight, straight


Breast tissue - extends end chest fold

Nipple position - over border that pec. Muscle

Lateral chest fold - tight, rounded


Breast tissue - extends end chest fold

Nipple position - 0 to 2 cm. Below border the pec. Muscle

Lateral chest wrinkles - gentle laxity, horizontal


Breast tissue – extends right into axilla

Nipple position – >1.5 cm listed below border of pec. Muscle

Lateral chest fold - small breast role in front of eight pit

Breast tissue – extends into axilla

Nipple place – ≥ 2 cm below border of pec. Muscle

Lateral chest wrinkles - breast role extends come the back of arm pit

Breast tissue – extends right into axilla

Nipple position – ≥ 2cm listed below border that pec. Muscle

Lateral chest fold - breast role extends around to back

Type 1 gynecomastia is much more commonly referred to as puffy nipples. Patients v puffy nipples will have tight skin. This allows the skin come wrap around the pectoralis border in a directly line, since there is little or no breast tissue blurring the muscle definition.In contrast, type 2 gynecomastia generally has breast tissue expanding over muscle border. This reasons chest fold rounding.

Type 1 appearance

Characterized by blown Nipples. Patient are frequently young, thin v a straight, well characterized pectoralis muscle.

What is walking on underneath?

Notice the firm, white, glandular organization located practically exclusively underneath the nipple/areola. This organization is what creates Puffy Nipples.

Unfortunately, the clinical meaning for optimal outcomes for gynecomastia is essentially non-existent; also in plastic surgical procedure literature. Form 1 does not important mean easiest. In fact, swollen Nipple patients room very details and execute not tolerate symptom such together persistent swollen nipple, cratering, contour irregularities, etc. Kind 1 patient are frequently in very great physical shape to begin. When puffy nipple is that the significant concern, there are countless other facets of form 1 that absolutely should be addressed in stimulate to not only attain optimal result but, much more importantly, prevent complications.

"Achieving optimal results and also avoiding complications requires both expertise and a plan" - Dr. Cruise
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The most common cause of bad outcomes is not having this plan. Unfortunately, gynecomastia treatment has actually never been offered the exact same attention that many other plastic surgical treatment procedures. This over-sight is the factor for this site. To create the abundant infrastructure to enable both patients and surgeons to interact their experience. To exchange ideas and also show not only what functions but additionally what doesn"t.

Anatomy of a woman Chest

External check out of mrs chest

Internal watch of woman chest

What specifies “Optimal Results?”

The prize is in reality very difficult to find. Contrasted to other clinical conditions, clinically relevant info is not available. This ignorance is unacceptable specifically because it has such far-reaching impact top top so countless men’s lives. Even plastic operated doctor are often vague regarding what is the best means to evaluate and also treat. To simplify this, Dr. Cruise outlines the 8 locations of the upper body that should be taken into consideration to administer a surgical roadway map that will predictably achieve your optimal results.

Eight Components

1. Chest shape - masculine, flat and defined Expand

Overall, a woman chest is full and powerful above the nipple but ripped and also defined below. The key is to create muscle definition, flatten the nipple, yet keep the chest area over the areola normal thickness. Thinning too much will produce a "fragile" appearance and also worse, may produce contour irregularities. The goal is come flatten the chest so the you can confidently wear tight white T-shirts and also to develop a V shape from both the back and former view. 

2. Nipple positionExpand

Ideally, the nipple must be 1-2 cm above the pec. Border (pectoralis major muscle). However, it is perfectly acceptable also if the is located directly on the border as lengthy as it sit on a convex (not concave) surface. This is specifically true with body home builders or guys with huge pec. Muscles as it offers the short lying nipple a bigger base to sit on. However, as soon as it sits listed below the pec. Border it begins to challenge downward or worse it falls into the chest fold which is concave. Sitting in the chest fold frequently gives the illustration of “cratering.”

3. Areola size, projection and also shapeExpand

The areola is the dark, pigmented skin about the nipple. Areola size is proportionate come chest size. Ideally, it need to 25-35 mm and also lay flush with the surrounding skin. However, slight key is common. Most civilization do not consciously establish it yet areolas space usually more comprehensive than they space tall. A perfectly ring areola is no ideal and also an areola that is taller than it is vast may even appear unusual or “surgical”. This is particularly relevant with varieties 4,5 and 6 i m sorry usually require reducing and also re-positioning the nipple through a cost-free nipple graft. A protruding nipple is common with puffy nipple because of the pressure from the swollen breast tissue below. However, there are instances where the nipple is merely enlarged. Fortunately, reducing the nipple by cut is right forward, low cost, small down time and very effective.

4. Pec. Border definitionExpand

Ideally, the pectoralis significant muscle need to be defined and straight v the skin wrapping about it into a well identified chest fold and also then into a characterized arm pit hollow. Excess chest tissue, fat and/or saggy skin will blur this border and create a round, feminine appearance.

5. Arm pitExpand

Not applicable to type 1

6. Three Fat pockets – pre-axillary, axillary and also breast rollExpand

Not applicable to kind 1

7. Chest rollsExpand

Not applicable to form 1

8. Ago rollsExpand

Not applicable to type 1

Surgical therapy Options

Incision visibility is less of an concern with type 1 Gynecomastia - swollen Nipples - contrasted to the various other types. This is because even the most aggressive incision (the exceptional crescent) still remains within the “forgiving” areola compared to the much less forgiving non-areola skin. Swollen nipples operation results commonly leave no clearly shows scarring.

Shorter scratch vs Optimal Chest Shape

Type 1 patients do not have actually much come worry around extra incisions as their skin is already tight. Your incision will certainly be limited to about the areola. There are some form 1"s that have an extremely low nipples. In this patients, nipple elevation is usually forced to prevent the nipple from "falling turn off the pectoralis border". If this happens, the nipple drops into the chest fold and it looks prefer it is "cratered". Clearly, not desirable. This needs a exceptional areola incision which is slightly much more visible but still not an issue.

Inferior Crescent Incision

Inferior crescent excision method that a 1/4″ come 1/2″ crescent shaped item of skin is eliminated just below the areola. This walk several an excellent things past tightening the chest skin. An ext importantly, it pulls the areola tight similar to gaining the wrinkles the end of a bed sheet. This small maneuver has actually a huge impact in gaining rid of excess skin that has been stretched over time. It also flattens the lower chest skin mildly so that it far better wraps about the pec. Border improving definition. The incision is situated low top top the areola where it is really hard to watch even early on on. Crescent incisions, however, produce skin spare that perform not line up exactly. The side toward the areola will constantly be much shorter than its counterpart. Suturing together this size mismatch may produce mild bunching that takes a little while come fade away.

Recovery Timeline

Click the image below to check out a complete timeline of the restore process following kind 1 swollen Nipples Gynecomastia surgery. Acquiring a much better understanding about what to suppose will help you properly prepare, plan, and also reduce stress.

Everything you need to know around recovery

Gynecomastia before & after Photos

View our collection of before and after photos to check out the results from kind 1, puffy Nipples, Gynecomastia surgery. Remember, each patient is unique and results will vary from person to person

kind 1 - swollen Nipples examples

Emotional cost of Gynecomastia

The pain and also suffering linked with gynecomastia is unlike any type of other problem in plastic surgery and also perhaps in every one of medicine. The variety of its affect is stunning. Some men (usually older) can be fairly unaffected while others (usually the younger) can be completely devastated and also even suicidal. 

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Unfortunately, since of the stigma connected with it, the is not always readily apparent what her loved one might be experiencing. In fact, the males or more commonly pubescent teenagers, who are many deeply affected go to great lengths to suffer alone. The net becomes the only one they can talk to. This dangerous combination of deep emotional pain and isolation renders them particularly vulnerable come exploitation. Exploitation that takes the form of the literally hundreds of "miracle" cures that have actually no clinical merit to the an ext nefarious varieties looking to take benefit of the the emotionally weak.

patient Perspective – common feelings connected with patients who have kind 1 Gynecomastia:

Trapped and alone during an important formation that self-worth period.Feels as if the is just one with problem.Unaware condition has a name: Gynecomastia. (However, net is transforming this).May or might not discuss involves with parents.High institution is emotionally challenging enough; gynecomastia deserve to be anywhere from uncomfortable to unbearable.Wide spectrum of exterior expression from normal to:Hunched neck and also shoulders.Downward gazing head/eyes.Uncomfortable v eye contactBecoming more and much more reclusive because that no apparent reason.PE class is torture.Feeling depressedPoor self-imageGiving upNegative affect on other aspects of life consisting of school, family, friends.


Insight indigenous a patient

I felt embarrassed having an femininely shame chest. Ns didn"t feel masculine and also it brought about me good anguish.

I avoided instances that compelled me to take my shirts off, prefer swimming. I would certainly hunch my shoulders so that my shirt would drape over my chest, because I was afraid other human being would an alert my chest. 

A girlfriend of mine told me I had man-boobs and also I instantly realized that other human being noticed what I had actually seen all along. I instantly felt embarrassed and also wanted to disappear. 

I would certainly wear loose fitting shirts and also hunch my shoulders so the my chest wouldn"t protrude. I was can not to stick mine chest out with pride (literally).

Try diet and also exercise to view if you can reduce the figure of your gynecomastia. If you"re quiet unhappy, research study a competent surgeon. That"s the course I took and I to be fortunate sufficient to discover Dr. Cruise. 

I did pursue gynecomastia surgery and the only regret I have is that ns did not perform it sooner. Ns am for this reason pleased with the outcomes that I deserve to not wait because that the summer for this reason I can walk follow me the beach v my shirts off. The boost to mine confidence has been enormous. I totally think it to be worth it. The biggest affect I"ve watched (besides mine confidence) is that I"m maybe to stand up directly again there is no worry about my "man-boobs" protruding. Something as basic as standing up right not only makes me look more confident, however I feel more confident. 

Vincent, 25

How parental can aid when they notice some or any of the concerns/signs below:

Observe. Is her son avoiding outdoor/shirtless activities he use to love?Does that wear shirt in ~ pool/beach?Is he an ext reclusive/negative?Does he decrease in academics?Does that come up through excuses to avoid PE?More apparent – is he gift ridiculed by schoolmates and also even friends, being dubbed titty twister, or being a topic of “man boobs” jokes, etc?Does he wear over-sized clothing? program tugging the shirt end chest?

Most of the time, your kid will not desire to “speak up” about his embarrassment the Gynecomastia. In addition, he probably does not also know over there is a surname for the condition that that suffers with. The vital here is to education the son on Gynecomastia. The best means is to an initial approach your child and also ask them why he has actually not been going come the pool or staying clear of shirtless situations. If you have a particular example, usage it. Have this conversation in a private place where he has actually your full attention and feels for sure to open up. Using media coverage such as the post in education OC is a an excellent way to break the ice. Part intro statements could be:

I noticed that you go not desire to walk swimming through your friends critical week, ns know exactly how much you love to swim, so I just wanted to check in and also make sure all is ok.It seems choose you have actually been no wanting to take part in tasks that require you to be shirtless and I just wanted to let you understand that if you space feeling self-conscious around an facet of her body, ns am below if you desire to talk about it.A many body alters can happen throughout the teen years and if something is happening to your body the you are not comfortable v or embarrassed about, you re welcome let me understand as I might be maybe to help you. I just read an write-up in education OC about Gynecomastia and also I believed it would certainly be great for you to look it end to check out if this is other you may be dealing with.

See more: Why Do Many People Say “ Where Is That At ”, Or “Where Are You At

Very important: Let your child recognize that you are judgement free.