Gland Excision for Steroid-Induced Puffy Nipples in a Muscular Patient

A 29-year-old personal trainer from Hyderabad had spent years building an impressive physique. But there was one problem he could not train away. His nipples puffed out, especially visible when he wore tight gym wear or went shirtless. The cause was a cycle of performance-enhancing supplements he had used three years earlier. Dr. Harikiran Chekuri at Redefine Clinic performed a precise gland excision through a minimal periareolar incision. The surgery took just over an hour, and his chest finally matched the physique he had worked so hard to build.

He had the chest most gym-goers dream of. Well-developed pecs, defined striations, low body fat. But something was off. His nipples puffed out like small cones. Behind each areola, he could feel a hard, rubbery lump. It started three years ago, shortly after he experimented with anabolic steroids during a competitive bodybuilding phase.

He stopped the steroids when he noticed the changes, but the gland tissue never went away. He tried everything the internet suggested. Anti-estrogen supplements. More chest exercises. Cutting body fat to single digits. Nothing worked. The lower his body fat got, the more obvious the puffy nipples became against his otherwise chiseled chest.

As a personal trainer, his body was his business card. Clients expected him to look a certain way. He started wearing loose tank tops instead of fitted ones. Avoided going shirtless for photos. The irony was not lost on him. He had built an impressive physique but could not show it off because of two small lumps. He finally decided to consult Dr. Harikiran Chekuri at Redefine Clinic.

WHAT WAS ASSESSED DURING THE CONSULTATION

A focused evaluation was performed:

• Physical examination revealed firm, disc-shaped gland tissue behind both nipples
• Grade assessed: Grade 1 (localized glandular tissue, no excess fat or skin)
• Composition: Purely glandular (no significant fatty component due to low body fat)
• Ultrasound confirmed dense glandular tissue measuring approximately 3cm diameter each side
• Hormonal panel: Normalized (steroids discontinued over 3 years ago)
• History of anabolic steroid use documented and cessation confirmed
• Patient goals: Flat nipples, maintain muscle definition, minimal scarring, quick return to gym

WHY GLAND EXCISION ALONE WAS CHOSEN

• Purely glandular gynecomastia with no fatty component to remove
• Liposuction unnecessary in a patient with 12% body fat
• Direct excision allows complete removal of the firm gland disc
• Small periareolar incision hidden at the natural color transition
• Faster recovery means quicker return to training
• Preserves the well-developed pectoral muscle definition

Baseline photographs documented the puffy nipple appearance against the muscular chest. Images were taken from multiple angles to show the glandular protrusion and its impact on overall chest aesthetics.

• Surgery performed under local anesthesia with sedation
• Periareolar incision made at the lower border of the areola (semicircular)
• Dense glandular disc carefully dissected from surrounding tissue
• Care taken to preserve a thin layer of tissue beneath nipple to prevent crater deformity
• Gland tissue completely excised from both sides
• Meticulous hemostasis achieved to minimize bruising
• No drains required due to minimal tissue disruption
• Incisions closed with absorbable sutures
• Compression vest applied immediately

The difference was immediate. Even with the post-operative swelling, his nipples lay flat for the first time in three years. By week three, when the swelling had subsided, his chest looked exactly how he had always wanted it to look. The pectoral definition was intact. The nipples sat flat against the muscle. The scars at the areola border were healing well and becoming less visible by the day. He finally had a chest that matched his physique.

Feedback recorded at the 4-week follow-up visit at Redefine, Hyderabad.

Note: Due to privacy regulations, we cannot display the patient’s name. This review has been shared with the patient’s written consent.

• Wear compression vest for 3-4 weeks (shorter duration due to minimal tissue removal)
• Keep incision sites clean and dry
• Take prescribed medications as directed
• No chest exercises or heavy lifting for 4 weeks
• Lower body and cardio allowed after 2 weeks
• Avoid direct sun exposure on scars for 3 months
• Apply scar treatment as advised once incisions heal
• Avoid anabolic steroids permanently to prevent recurrence

DISCLAIMER: This case study is for informational purposes only and does not constitute medical advice. Individual results may vary based on the type and grade of gynecomastia, body composition, and healing response. Steroid-induced gynecomastia may recur if performance-enhancing substances are used again. Consult a qualified plastic surgeon before undergoing any procedure. Patient feedback published with written consent. Patient identity withheld per confidentiality guidelines.