Nipple Surgery Service
For many men and women, long or oversized nipples can be an embarrassment, and nipple surgery presents a safe, quick way to address the problem permanently. An increasing number of patients are requesting nipple reductions, either in combination with a breast augmentation, lift or reduction, or simple as a single procedure. Many women request a nipple reduction because breast feeding has permanently altered the shape and size of their nipples, making them longer and somewhat droopy. Nipple reductions illustrate the point that even a minor procedure can completely alter an individual’s self-perception for the better, increasing confidence and poise.
What many women think of as “the nipple” is actually made of two parts: the nipple and the areola. The nipple is the projected part and the areola is the dark pigmented skin that surrounds the nipple.
Surgical Reduction of the Nipple: First, the doctor will determine which part of the nipple needs to be reduced. Depending on the shape of the nipple this could be a reduction in length, a reduction in width, or both. This is often performed under a local anesthesia.
Length reduction: Nipples that are too long either droop down or project too far out. Usually, to create a shorter nipple length, the tip of the nipple will be removed and sutured for closure. Sometimes the skin along the neck of the nipple will be removed. In those circumstances, the tip of the nipple is then sutured to the bottom of the nipple, creating a shorted nipple length.
Width reduction: If the nipple is too wide (or thick), but not too long, a pie-shaped wedge will be removed from the undersurface of the nipple. This allows the nipple to be “taken in” and the circumference reduced. Dissolving sutures are used.
Length and Width reduction: For some people the nipple may be too wide and too long. In those cases, both procedures are performed. The healing and the procedure used for a nipple reduction depends to a degree upon the anatomy of the nipple enlargement and the amount of nipple reduction desired by the patient.
There are many methods used by various surgeons, including removal of just the top of the nipple, which is then closed with tiny incisions. Nipple reduction may also involve removing a cylinder of skin around the neck of the nipple, then pushing the nipple back into the breast tissue and suturing the skin closed.
Sensation is almost always normal following a nipple reduction, and the ability to breast feed can usually be easily preserved. If the procedure is not being combined with other cosmetic surgeries, then a nipple reduction is often performed in the physician’s office with a local anaesthetic. There is very little discomfort, and most patients having a nipple reduction will not require any type of sedative. The recovery time is almost nonexistent: patients may return to work or other normal activities within hours of having their nipple reduction, and showers are permitted the following day. The sutures may be dissolvable, or the patient may return to the doctor’s office 4 to 7 days after the nipple reduction to have the stitches removed. The swelling and pain are minimal, and results are almost instantaneous and very natural in appearance, with nipples that have normal sensation and reduced projection.
Features of inverted nipples are usually evident as a slit or hole in the breast at the location of the nipple. It may be possible to pull the nipple out or not. It may be present on one or both sides. It is usually a congenital situation but may be related to scarring from breast-feeding or infection in the ducts or a previous breast surgery. Nipple inversion can cause functional problems such as irritation, rash and discomfort. It may prevent the ability to breast-feed. Correction is sought most often because it is a cosmetically undesirable condition and women simply do not like the way it looks and want it improved.
Depending on the grade of contracture and patient expectations, sometimes the milk ducts need to be cut and other times not. Correction depends on cutting the milk ducts if they are scarred and contracted (Grade III) or not cutting them if little or no contracture is present (Grades I and II).
If the milk ducts are cut then breast-feeding will not be possible. Since it is not possible to breast-feed with Grade III inverted nipples most patients want them repaired.
The procedure can be done under local anaesthesia in the office. It is so comfortable and well tolerated that patients usually do not need any sedation at all. Small incisions are made directly in the nipple and the repair is completed. A light dressing is used. Drains are not needed. The procedure can be combined with other procedures including breast enlargement, lift, or reduction.
Recovery is very rapid. Return to work and most activities can be within hours. Showers are permitted the next day. Sutures are removed in 4 to 7 days. There is minimal pain or swelling. Sensation is normal immediately or returns fully within several days.
The results are very natural appearing nipples that have normal sensation and projection. It will maintain the result forever. Rare complications may occur such as recurrence of the inversion and this may be complete or partial. Sensation is usually completely normal as is muscle activity and response to touch and hot and cold. The scar is imperceptible.
The pigmented portion surrounding the nipple is called the areolae and it may be enlarged or puffy. This may occur on one or both sides. This may occur in women or in men. It can be enlarged in diameter and have different degrees of coloration. This is often a congenital situation or may be related to massive enlargement during breast feeding after which they never went back to normal diameter. Either situation can be improved with surgery known as areolar reduction. This involves an incision around the edges of the areolae then removing a thin donut-ring like width of areolar skin, and closing this incision. It ends up as a ring around the reduced areolae. It is also easy to perform in the office under local anaesthesia. Return to work and activity is just as described above for the nipple surgery. There is no risk of sensation or nipple duct problems. There is a slight risk of unsightly wide scars but this is often prevented by taping, massage and cream therapies early after surgery