Both men and women who are not happy with the appearance of their nipples and/or areolas (the darker skin around the nipple) can benefit from cosmetic nipple and areola surgical procedures.
Nipple and areola surgery can be a part of cosmetic plastic surgery or reconstructive plastic surgery; for example, during breast reconstruction revision after breast cancer.
Dr. Ginger Xu is a board-certified plastic surgeon who specializes in aesthetic plastic surgery and understands the importance of aligning each person’s appearance with their goals and identity. Dr. Xu was fellowship-trained in aesthetic plastic surgery at Harvard and is now based in the San Francisco Bay area.
Cosmetic nipple or areola surgery is a term to describe any surgical technique that changes the size or shape of the nipple and areola. The nipple and areola are collectively called the nipple-areola complex (NAC). The nipple is a projection of skin with:
- A rich nerve supply making the nipple more sensitive than skin
- Blood vessels
- Milk ducts that end in the nipple and deliver milk during breastfeeding
Any cosmetic plastic surgery for the nipple-areola complex aims to preserve the nerves, blood vessels, and milk ducts so that sensation and the ability to breastfeed are maintained. There is always a small risk that these things will be affected. For this reason, women who are planning to have a family should consider delaying the surgery until after they have completed pregnancy and breastfeeding.
Differences in the appearance of the nipple and areola can be:
- Present at birth
- More obvious as the breasts develop during puberty
- Affected by life experience – weight gain and loss, pregnancy, breastfeeding, or age
Surgery to improve the appearance of the nipples and areolas can be performed alone or as part of other procedures such as:
Patients may seek areola and nipple correction surgery for a range of reasons.
Patients usually want surgery to correct large, elongated, or prominent nipples because their nipples are conspicuous under clothing and can be irritated with constant rubbing.
Some have unusually large nipples at birth. Large nipples can also develop over time, especially after breastfeeding. Men with enlarged breasts can have enlarged nipples as well.
The appearance of one or both enlarged nipples can be improved with a nipple reduction. A small incision made at the base of the nipple enables the surgeon to correct the length, width, or circumference of the nipple.
The scar is hidden beneath the nipple and nipple sensation and ability to breastfeed are usually maintained.
The size of the areola varies widely among women and also in men with enlarged breasts. The potential to develop large areolas can be genetic, or areolas can stretch as breasts become larger after a life event, such as:
- Weight gain followed by weight loss
- Breast augmentation
- Sagging as a natural part of aging
Cosmetic plastic surgery can help people who are uncomfortable with the size of their areolas. Areola reduction surgery decreases the diameter of the areola and can also improve puffy or protruding areolas which are seen in women with tuberous breasts, or men with gynecomastia. The surgeon removes a donut-shaped piece of tissue from the areola, with the incisions along the border of the areola helping to camouflage the scar.
When performed alone, areola reduction is a relatively quick procedure that takes up to one hour. Most people can resume normal activities after three days, with complete recovery taking up to three weeks.
Once the swelling and bruising have decreased, there will be a circular scar around the border of the new areola which fades with time.
The nipple and areola can hang low on one or both breasts, especially when women have significant sagging of the breasts (ptosis) because of:
- Large breast size
- Weight loss
Nipple–areola complex lifts are therefore usually a part of both breast lifts for sagging breasts and breast reductions for large breasts. They are not usually performed alone but might be suitable for women who would like a minor breast lift.
Also known as a crescent breast lift, the surgeon makes a crescent-shaped incision around the top of the areola and then raises the nipple and areola to a more aesthetically pleasing position. This technique results in a scar that is camouflaged along the border of the areola.
An inverted nipple is one that does not protrude outward but is instead pulled deeper into the breast tissue resulting in a flat, sunken, or tethered appearance. For some people, an inverted nipple impacts their self-esteem and they want to correct this.
The degree of nipple inversion ranges from a so-called “shy nipple” (that will protrude when stimulated by cold or touch), to a nipple that is permanently inverted and will not protrude with stimulation.
Inverted nipples occur naturally in up to one in five women and in some men. Inverted nipples are caused by short milk ducts that pull the nipple into the breast. This can also occur after breastfeeding when tissue changes cause retraction of the nipple.
People are usually born with the potential to develop inverted nipples, which can become apparent in childhood, adolescence or adulthood. Inverted nipples do not usually cause medical problems, but if an inverted nipple suddenly appears it could indicate the presence of breast cancer. Women who suddenly develop an inverted nipple should consult a doctor.
Inverted nipple correction is performed by making a small incision at the base of the nipple and releasing the tethered milk ducts. The milk ducts may either be stretched or cut, depending on the severity of the case. If the ducts are cut, they will no longer transport milk through the nipple and thus breastfeeding will not be possible. Scarring is hidden at the base of the nipple. Any contraction of the scar will help to keep the nipple in a protruded position.
Women who are planning to have a family may wish to delay this type of surgery until breastfeeding is no longer a concern. They can discuss the possible options with Dr. Xu.
In some cases, the size, shape, or position of the areolas may be different between the two breasts, creating asymmetry. The areolas themselves can also have an irregular shape. Women with tuberous breasts may have large or irregular areolas. The appearance of the areolas can be improved by making incisions around the areolas designed to smooth out the borders and improve symmetry.
Most women have some breast asymmetry. Asymmetry of the nipples can be more noticeable and bothersome. The surgical options to correct nipple asymmetry will depend upon the individual case. Typically, the core nipple tissue must be reshaped to improve contour and symmetry.
The techniques used to correct asymmetry can include the nipple and areola surgical techniques described above combined with other techniques including breast lifts, reductions or augmentation – these often also involve correction of the position of the nipple and areola.
Additional breast, areola and nipple tissue can form along the “mammalian milk line.” The milk line runs down both sides of the body, from the armpits, past the outside of the chest and abdomen.
The appearance can range from additional nipples or small pigmented areas that look like moles to noticeable breast tissue that can increase in size with hormonal changes, for example during menstruation and pregnancy.
In some cases, the extra nipples and breast tissue can produce milk and people who have this condition can find it embarrassing.
Supernumerary nipples and accessory breast tissue can be easily surgically removed.
If you are planning more pregnancies, Dr. Xu recommends delaying nipple surgery until after you have finished breastfeeding. There are two major reasons for this recommendation:
- Surgeons always aim to keep the nerves, blood vessels, and milk ducts intact, if possible. However, there is some risk that the ability to breastfeed may be affected by nipple surgery
- Breasts and nipples change with pregnancy and breastfeeding and this can affect the appearance of any previous breast enhancements
Nipple surgery can be a part of the combination of surgeries for a mommy makeover. Dr. Xu can advise you which surgical options will give you the best possible results.
Procedures involving combinations of surgeries are more complex and it is important to choose a well-experienced surgeon. Dr. Xu has the technical experience and artistic sense to work with you to achieve realistic goals as close as possible to your vision for your body.
As with all surgical procedures, there are a few important things to prepare for both pre- and post-operation. If you have any questions, make sure to be up front with Dr. Xu so she can properly assess your concerns.
Once you and Dr. Xu have agreed on an approach to your surgery, Dr. Xu will book your surgery time and give you instructions on what to do before and after your surgery.
Dr. Xu will also let you know which medications you should and should not take prior to your surgery and what to do on the day of your surgery. It is important to stop smoking at least 6 weeks prior to surgery.
You may need to get a blood test or undergo additional workup depending on your medical history. Dr. Xu may also correspond with your primary care doctor to ensure you are in an optimal state of health prior to surgery.
In the weeks before surgery, recommendations to help you prepare include:
- Make sure you get enough sleep and rest
- Eat a healthy diet with adequate protein and nutrition
- Exercise or engage in physical activity to strengthen your body
- Maintain a positive state of mind
- Prioritize your well-being and reduce stress levels
It is essential that you feel comfortable about your upcoming procedure and fully understand the process. Dr. Xu encourages her patients to ask any questions about their surgery or recovery.
Nipple and/or areolar techniques are relatively quick surgeries of one to two hours. You can usually return to work within two to three days and resume normal activities after three to four weeks. During recovery, you should avoid lifting heavy items.
After your nipple surgery, you will feel some discomfort. Any pain should be relieved with over-the-counter or non-opioid medications.
If you have a combination of surgeries including breast lift, reduction, augmentation or a mommy makeover, your recovery time will be longer. Dr. Xu can advise you of additional recovery needs.
Cosmetic nipple surgery aims to preserve the nerves, blood vessels and milk ducts of the nipple so that sensation and the ability to breastfeed are maintained. Sensation in the nipple usually returns over time but in rare cases, sensation never returns. Likewise, there is no guarantee that breastfeeding will be possible after nipple surgery.
Dr. Xu recommends women who are planning to have a family consider delaying the surgery until after they have completed pregnancy and breastfeeding.
Nipple surgeries are relatively straightforward and have high rates of success. But like all medical treatments, there is some risk of side effects, such as:
- Loss of sensation – any loss of sensation usually resolves with time but in rare cases sensation never returns
- Scarring – this is usually hidden under the nipple or camouflaged at the border of the areola and the breast skin. Scars often fade with time but never disappear. If there is significant scarring, scar revision techniques can help to improve the appearance of scars
- Inability to breastfeed – surgeons aim to protect the integrity of the milk ducts. In rare cases, milk ducts can be damaged and you may be unable to breastfeed. Some women are unable to breastfeed even without any breast procedures
- Infection – this is always a risk with any surgery and following your surgeon’s instructions for the recovery period will decrease this risk
The cost of nipple and/or areola surgery will depend on whether they are performed alone or in combination with other procedures, such as breast lifts, reductions or mommy makeovers.
The combination surgeries are more complex and will cost more. The best way to understand the costs of surgery is to schedule a consultation with Dr. Xu. Dr. Xu is a board-certified plastic surgeon with a high level of technical expertise and the sense of artistry necessary to help people achieve their aesthetic goals.
Many people are unaware of the full scope and possibilities of plastic surgery. Dr. Xu will listen to your vision for your body, review the options that are available to you, and advise you on an optimal surgical plan that will best meet your needs.