Episode 35: How Can I Fix My Nipples?
How can I fix my nipples? This is a question we're asked frequently by people that are having other kinds of breast surgery, like a breast augmentation or breast reduction, or a breast lift. And sometimes by folks who are purely concerned with the appearance of their nipples in isolation. The appearance of the nipples is a concern for both men and women. And it's actually something we deal with pretty frequently.
What is a nipple? What is an areola?
Before we dive into nipple aesthetics and size and shape and position, the first thing that we should really do is establish some vocabulary.
So the nipple is, simply put, the thing that sticks up in the middle of the breast on both men and women. The areola is the usually circular portion of the breast in both men and women, that is pigmented more darkly than the surrounding skin. So, together, the nipple and areola are called the nipple areola complex. And there are specific concerns that both men and women have with the size, shape, and position of both their nipple and their areola.
So, let's go structure by structure. The nipple itself is fairly straightforward, and this is something that someone may feel is either too big, in the sense that it projects or sticks out too far from the breast or, on the opposite end of the spectrum, that it is inverted or that it actually recedes back into the breast rather than sticking out.
So, if a nipple projects too far from the breast, there are various kinds of nipple reduction procedures that we can perform. And a very popular option for this is we simply remove a ring of tissue around the outside of the nipple and collapse the nipple on itself almost like we're folding a telescope back in on itself and we suture it together. And that will very reliably reduce the degree to which the nipple projects.
For nipples that are inverted or that stick back into the breasts instead of projecting outwards, there are several ways that we can approach the correction of inverted nipples. And this is generally a matter of making very small incisions or even just using pokes from a needle to break up the fibrous bands of connective tissue that are drawing the nipple back towards the chest wall, into the breast.
Often after these procedures, the nipple has to be suspended in its new everted position, either with sutures or even with a nipple piercing so that it can heal in the proper position and doesn't contract again, back into the breast mound.
The results of this procedure aren't quite as reliable as those that we can see from nipple reduction procedures. And there is a certain amount of relapse that can occur and requires a secondary or revisional inverted nipple correction procedure.
The other important thing to know about nipple inversion correction, and also the correction of nipples that project too far out, is that these procedures can interfere with both nipple sensation and the patient's ability to breastfeed. So these are specific things that you should discuss with your plastic surgeon before having either one of these procedures.
So, moving on from the nipple to the areola, we can discuss both the size and position of the areola, as well as its shape. So essentially the most common complaints about the areola are either that it is too large in relation to the rest of the breast or that it is too low in relation to the rest of the breast. In some instances, usually after another surgical procedure, like a breast reduction or a breast lift, the areola can have an irregular shape. And this is something that we also sometimes need to repair.
Before we discuss the position of the areola, let's discuss issues having to do with its size. An areola can either just be large due to heredity, or sometimes it can become enlarged after pregnancy and breastfeeding. In any event, this is a relatively straightforward issue to correct.
And the way that we do this is we will carefully design an excision of the outer rim of the areola to bring it to its desired shape and size. And then suture the border of the new areola to the surrounding skin.
In some instances, usually in cases where we're performing a quite significant areola reduction, we may use permanent sutures to ensure that the areola remains steady in its new size and shape and spreading doesn't recur. Since there will, by definition, be some tension on the repair since we have removed the outer rim of the areola and the rest of the breast tissue is essentially tugging on it.
Since in other breast procedures like a breast lift or a breast reduction, the areola is often moved on the breast mound, its shape can become irregular and less round. And this is addressed in essentially the same way as an areola that is too large. We use a template to design a very round contour of the areola, and then simply excise a portion of the areola that lies beyond this template. And then we suture the remaining areola to the surrounding breast tissue.
And the template is actually called a cookie cutter because it is round and one side of it is sharp so that we can use it to mark the skin and it looks a lot like a cookie cutter. In terms of the position of the areola, this is something that we usually encounter in folks who are concerned about drooping of the breasts or what we call breast ptosis, where it appears that the areola is too low on the breast mound and too low on the chest wall, such that the breast has a deflated or saggy appearance.
And this is something that we treat with a mastopexy or breast lift. And there is an earlier episode you can listen to for details about how mastopexies and breast lifts are performed.
So, while it's more common for women to have concerns about the size and shape of their nipple and areola, this is something that we do see in men as well. And the procedures used to address these issues are very similar to those that are used in women.
What is nipple and areola surgery like?
The nice thing about procedures to address the form of the nipple and areola and the nipple areola complex is that they can almost always be performed with straight local anesthesia, meaning you don't need to go to sleep. You can be awake and breathing on your own, but we use local anesthesia to make sure the area is numb and you don't feel any discomfort. Of course, general anesthesia or twilight anesthesia remains an option, so you don't need to be awake, but the option is there if you'd like to have a more rapid straightforward recovery.
So this is something that you can literally come in, have done, and then just walk out of the office. The whole thing for many of these procedures takes under an hour. This is not the case for our breast lift or mastopexy. This is a more invasive procedure that is performed under general anesthesia.
And again, there's more information about breast lift and mastopexy in an earlier episode. So issues with the nipple and areola are very common in women. We also see them in men and they usually are fairly straightforward to address.