Nipple and Areola Surgery
Plastic surgery on the nipple and areola – the pigmented tissue around the nipple – may be performed as separate, isolated procedures on the breast, or concurrently at the time of other cosmetic breast plastic surgery such as breast augmentation, breast lift, or breast reduction surgery.
Plastic Surgery of the Nipple
The three most common aesthetic plastic surgery procedures on nipples are:
- Inverted nipple correction
- Nipple reduction
- Accessory nipple removal
Inverted Nipple Correction
Inverted nipples may occur on one or both breasts, and are the result of shortening or tightening of the ducts that run within the nipple. The condition can be classified according to severity, from mild cases in which there is minimal inversion and the nipples are still capable of becoming erect in response to stimulation, to severe cases where the nipples remain retracted despite stimuli such as touch or cold.
Plastic surgery to correct inverted nipples involves a small incision across the base of the nipple, releasing the duct contraction, and suturing the nipples in a normal, everted or erect position. When done concurrently with other breast procedures, there is no significant additional down time or recovery necessary. If done independently, inverted nipple correction can be carried out under local anaesthesia alone or using only minimal sedation.
Nipples may become enlarged, or hypertrophic, and assume a droopy, floppy, hanging appearance. The condition occurs either in conjunction with or separately from breast enlargement, and may also be seen in patients with very small breasts who wish to undergo breast augmentation surgery. Hypertrophic nipples may be present on one or both breasts, and exhibit different degrees of enlargement.
Plastic surgery to correct enlarged nipples involves measuring the desired new height of the nipple, placing a small incision at the appropriate level to excise the excess tissue, and using sutures to recreate a normal nipple contour. Recovery is short and there is no significant additional down time or recovery necessary when nipple reduction is performed concurrently with other breast procedures, such as breast reduction, breast lift, or breast augmentation. If done as a separate procedure, nipple reduction surgery can be carried out under local anaesthesia alone or using only minimal sedation.
Accessory Nipple Removal
In some women and men, extra nipples and areolas may appear in addition to the main right and left breasts and nipple-areola complex. These accessory tissues may present as isolated nipples, with or without areolas, and occasionally with additional breast tissue underlying the pigmented skin. These accessory nipples often lie as 1-4 lesions along the mammalian milk line, from up just in front of the underarms and inferiorly diagonally across the chest and upper abdomen. Depending on the size and associated tissues, they may respond to hormonal stimuli similarly to normal breast tissue.
Removal of accessory breast tissue involves an incision to include the pigmented nipple and areola, as well as any underlying breast tissue. The procedure is usually performed under local anaesthesia alone, and results in permanent removal of the excess tissues. Recovery is rapid and discomfort is minimal. Patients are usually extremely satisfied with the results and most derive both physical and emotional benefits from accessory nipple removal surgery.
Plastic Surgery of the Areola
In some women, the areolae may occasionally be enlarged or misshapen. This may be a normal congenital variant, or result from overall breast enlargement or pregnancy, or as a results of prior breast surgery. Either one or both areaolae may be affected, and plastic surgery to improve the appearance of the areola may be performed on either one or both breasts.
Areola reduction is possible during concurrent breast enhancement procedures, such as breast lift, breast augmentation, and breast reduction surgery. In these cases, it may be performed using the incisions necessary for the breast enhancement procedure. Plastic surgery on the areola may also be performed uniquely as a separate procedure, in which case it most often requires a periareolar or circumareolar incision, circumferentially around the scar, producing a circular scar around the periphery. When performed on its own without additional breast enhancement procedures, areola reduction only requires local anaesthesia, although sedation may be administered for patient comfort. Results are immediate and recovery usually requires minimal downtime.
Dr. Hutchinson often performs nipple correction surgery and aesthetic areola surgery either alone or in conjunction with other aesthetic breast surgery such as breast augmentation, breast lift, and breast reduction in women and gynecomastia correction in men. She will discuss the various options available for nipple and areola surgery and determine which surgical plan offers the best possible results for you.
The Nipple and Areola Surgery Patient’s Frequently Asked Questions
Q: Am I a good candidate for nipple and areola surgery?
A: Patients who may benefit from nipple and areola surgery most often have concerns about the following:
- nipples that are too large, too prominent, or too wide
- sagging or droopy nipples
- inverted nipples that may become erect when stimulated
- irregularly shaped, bifid, or bilobed nipples
- asymmetric nipples with different sizes or shapes
- extra nipples (“supernumerary or accessory nipples”) with or without underlying breast tissue, usually seen on the breasts, torso, or in the underarm area
- enlarged areolas
- irregularly shaped, elongated, or non-circular areolas
- asymmetric areolas whose appearance do not match
Q: What should I expect during my nipple and areola surgery consultation?
A: Your initial consultation with Dr. Hutchinson includes the following:
- a comprehensive in-person discussion with Dr. Hutchinson when she will obtain your medical history and you will have time to explain what bothers you about your nipples and areolas and what results you hope to achieve with plastic surgery
- after your conversation, you will be seen in a private examination room where she will perform a detailed physical examination and assess your unique physical characteristics
- she will also take medical photographs which provide additional information when discussing your nipple and areola surgery
- following your examination, Dr. Hutchinson will discuss surgical options, determine the best customized surgical plan for you to achieve your goals, and review your medical photographs with you
- Dr. Hutchinson will also provide you with specific details regarding the bespoke aesthetic surgery she creates for you as each patient’s plan is based on individual features and desired outcome
- she will also inform you of what is required from you before and after your surgery to ensure a successful operation and smooth recovery
- you will be given ample time to ask any questions you have in order to feel comfortable with your decision
- you will also have an opportunity to schedule your nipple and areola surgery once you have decided to proceed
Q: How will my nipples and areolas look after surgery?
A: Every patient has a unique nipple and areola anatomy, and each has her own wishes for how she would like to look after her plastic surgery. In order to help you understand what results can be achieved with your nipple and areola surgery and what is the best possible option for you, Dr. Hutchinson will discuss with you specific details of your current breast, nipple, and areola characteristics. Factors that may affect your results include:
- current nipple appearance including:
- size and contour of nipples
- degree of nipple protrusion or sagging
- extent and reversibility of nipple retraction or inversion
- symmetry between nipples
- number, size, and location of any accessory nipples
- size, shape, and symmetry of areolas
- skin characteristics, such as laxity, elasticity, and tone
- scarring from prior surgery
- plans for future pregnancy and breastfeeding
Q: How should I prepare for my nipple and areola surgery?
A: Dr. Hutchinson provides her patients with detailed and precise instructions to be followed prior to surgery, which include the following:
- Dr. Hutchinson will make recommendations for each patient including:
- breast imaging including mammogram, sonogram, and/or MRI as necessary
- requirements for medical clearance and bloodwork prior to surgery
- patients should be active participants in optimizing their wellness, including:
- maintaining a healthy lifestyle, diet, and weight
- avoiding smoking
- not taking medications that can increase risk of complications
Q: What should I expect after my nipple and areola surgery?
A: Every patient will have their own personal experience and recovery after surgery, although some common aspects of their post-operative course include the following:
- changes are immediate and results long lasting
- some discomfort, swelling, and bruising are normal in the first few days after surgery
- nipple sensation and breastfeeding ability may be affected by surgery
- it is essential you closely follow the detailed instructions provided by Dr. Hutchinson