One of the most common forms of the gynecomastia breast is the “puffy nipple”, according to Wikipedia. I find this to be true with my San Francisco, Bay Area patients seeking male breast reduction.
The dome effect is caused by dense breast tissue under the nipple areola area. This is the area where the breast bud develops and can grow to various sizes in the teenage years. Young men, more than older men, seem to be affected by the “puffy nipple syndrome”.
Many gynecomastia patients have noted that when the nipple is cold or in water that the puffy nipple is improved, this is because the muscle in the areola contracts upon stimulation, but once the stimulation is removed, the puffiness will return. The cone shape of the nipple is caused by lack of fat making the tissue protrude, thus the appearance of puffy nipples.
Sometimes gynecomastia (moobs) will resolve on its own by the end of puberty. However for some it will become a permanent condition. When my patients ask what their options are, I tell them that the treatment for the puffy nipples is the same as for the gynecomastia surgery, in that the gland needs to be excised. This is done by an incision around the areola freeing up the gland from deeper tissue, then the nipple is allowed to shrink and flatten out once the fullness is removed.
Treatment of puffy nipples is very successful and the satisfaction rate is extremely high.