Joseph T. Cruise, M.D.
EXCELLENCE IN PLASTIC SURGERY

NEWPORT BEACH | ORANGE COUNTY

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Puffy Nipples

Puffy Nipples differ from Classic Gynecomastia in that the nipple and areola are cone shaped causing the areola to appear “Puffy”. On an ideal chest, the areola is even with the surrounding chest skin. When there is a case of “Puffy Nipples”, the areola projects outward. This is especially true in warmer or hot temperatures. Many men routinely complain that their nipples are too visible in thin clothing during hot weather.

Diagram of ideal, youthful male chest Puffy Nipples and Gynecomastia - male breast reduction from Orange County plastic surgeon Dr. Cruise
Ideal Chest Puffy Nipple

Patients with Puffy Nipples are typically thin and in very good shape. This can be especially frustrating as no amount of diet and exercise reduces the conical shape.

What causes Puffy Nipples?

Ideal nipple on male chest Male chest with puffy nipple gynecomastia
Ideal Chest Puffy Nipple

Puffy Nipples are usually caused by an excess amount of breast tissue directly underneath the nipple/areola. This breast tissue pushes the nipple outward and makes it overly visible, especially in thin shirts. Additionally, it pushes the entire areola outward so that it is no longer even with the surrounding skin, causing a “puffy” appearance. Again, this is particularly evident in warm weather. Unlike Classic Gynecomastia and other types of gynecomastia, the Puffy Nipple does not present nearly as much fat which means liposuction alone is unlikely to be an effective course of treatment. Liposuction will reduce the overall volume, but in many cases it actually accentuates the breast tissue, making the chest appear even more cone-shaped.

Male chest with puffy nipple gynecomastia - side view Male chest with puffy nipple gynecomastia - front view
Puffy Nipple – Profile view Puffy Nipple – Front view

Notice how the chest in the above case does not round out as much as classic gynecomastia. Instead, the chest fold maintains a relatively horizontal orientation. The rounding you see is from excess fat or breast tissue along the bottom and lateral part of the chest.

On the profile view, the nipple and areola projects outward from the skin giving a “puffy” appearance. Additionally, excess breast tissue directly beneath the nipple causes the nipple to appear pointy, making them more noticeable in clothing.

Diagram showing muscles of male chest with puffy nipple gynecomastia
Puffy Nipple – Cut out view

The cut out view shows the Puffy Nipple is conical in shape. The breast issue, which is located directly below the areola, creates a cone with the nipple on top. Also apparent is the relative lack of fat when compared to classic gynecomastia, which is why the chest is not so rounded out. Once again, removing the fat with liposuction without removing the breast tissue will make the nipple appear even more cone shaped.