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Monthly Archives: June 2013

Nipple and/or Areola Revision with Breast Reduction

Posted on: June 16, 2013
By: DrDelgado

This is a 52-year-old resident of San Francisco was seen for a breast reduction. She underwent a vertical short scar breast reduction in which her size was reduced from a DD to size C. Notice the reduction in the size of the areola.

What many people think of as the nipple is actually the nipple and the areola. The nipple is the part that projects out and delivers milk via the milk ducts, and the darker pigmented circle of skin from which the nipple projects is the areola. As with the rest of our body, the breasts, nipples and areolas come in all sorts of shapes and sizes. For many people, men included, having large or puffy areolas or protruding or inverted nipples can cause a great deal of embarrassment. This is especially true when the nipple protrudes to the point of being visible through clothing. Corrective surgery can be done for both the nipple and areola or separately.

The size and shape of the nipple areola complex can be genetic, or some changes may have occurred due to weight fluctuations, aging, pregnancy and or breastfeeding. In any case, together the nipple areola complex is one of the most important cosmetic aspects of the breast.

When women elect to have breast reduction surgery, many opt to have the areola reduced and/or the nipple shortened. Men who have male breast reduction surgery, also known as gynecomastia surgery, may also have areola and/or nipple reduction at the same time. In some cases, the breast may not need to be reduced, allowing the areola/nipple revision procedure to be performed as a somewhat minor surgery.

The ideal nipple is shaped like a cylinder with a dome like curved top. There is no standard to the length of the nipple; some people prefer them to be shorter and some like them longer. Inverted nipples can look flat or like a slit or hole in the normal place of the nipple. This happens in different degrees with the severity graded from 1 to 3 with 3 being the most severe. For grade 2 and 3 breast feeding may be a problem. Inverted nipples usually result from a narrow nipple base and or short milk ducts. It can affect one or both nipples.

For the elongated nipple, the tip is often removed and sutured, or the nipple may be shortened by excising skin along the neck of the nipple. If it is the width of the nipple that needs to be reduced, a pie shaped wedge of skin is usually removed from under the nipple.

The goal in surgery is to reshape the nipple and get projection while preserving the sensitivity of the nipple and leaving the milk ducts intact.

To reduce the size of the areola, two concentric incisions are made around the edge of the areola with the inner circle the new radius, leaving the area around the nipple intact, still attached to its blood supply and the milk ducts. Then removing the donut shaped piece of tissue and skin the outer circle is stitched to the inner circle in a purse string fashion creating the new smaller areola.

Whatever your goals are, your first step would be to schedule a consultation with Dr. Delgado and he will be able to explain your options in detail. If you are considering a combination of procedures, be sure to let him know so he can discuss the possibility with you.

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