Should the ‘normal’ and ‘ideal’ nipple position in a male influence the surgeon when planning severe gynaecomastia correction?

Abstract Background : The ideal nipple areolar complex (NAC) position of the male chest following gynecomastia surgery is well documented, however with increased development of the chest muscles, the NAC placement can change, leading to the medial displacement of the nipple giving a poor aesthetic outcome. Therefore, we feel these measurements need to be applied to the patients build and take into consideration the patient's future fitness goals. Method : We have analysed photographs of 3 groups of men: super- athletes, athletes and severe gynaecomastia. We assessed the proportions of the chest in relation to the NAC, degree of ptosis and TAP index. Results : There was a wide variation between the athlete and super athlete group, with minor variation within each group. The range of measurement in the severe gynaecomastia group was significantly larger than the other groups. We feel that based on this research surgeons should however be somewhat circumspect in their choice of nipple position as there is a wide variation in what can be considered as normal and positioning of the nipple areolar complex too early in the recovery process may lead to an abnormal aesthetic appearance following muscle development. Conclusion : Despite the multitude of techniques available to determine the position of nipple in the literature there is a lack of understanding on how the NAC position changes with muscle development. The focus on a dogmatic approach may result in very aesthetically displeasing result which can be very difficult to correct in men.