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The nipple-areola complex is the highlight of an aesthetic breast mound. In youth, the nipple-areola complex lies on the apex of the breast mound, and the nipple adds further projection to this mound. An aesthetic nipple-areola complex lies at the intersection between the vertical midline of the collar bone (clavicle), and a horizontal line above the inframammary fold. An aesthetic areola is one that is in the correct position and of appropriate size. It adds a final touch to the aesthetic of the breast mound.
There are normative measurements for the average areola and nipple diameter and projection. There is also individual variance on what is considered aesthetic and what is regarded as proportional for a person’s height and breast size. Enlarged areolas may cause social embarrassment with certain styles of clothing or swimwear, and may lead to diminished self-confidence and withdrawal from certain social or athletic activities. Enlarged areolas are also often darker in color and many individuals seek lightening of the skin tone. Sometimes, the nipple may be enlarged together with the areola and it is possible to correct both at the same surgery.
Nipples may enlarge and elongate due to hormonal changes arising from pregnancy and breastfeeding, or male breast enlargement (gynecomastia).
Areola reduction surgery reduces the areola diameter and restores proportionality and the breast or chest aesthetic. Nipples that are elongated or enlarged may also be reduced during the same surgery. Areola reduction is a simple procedure that restores body image, self-confidence and improves social functioning. Areola reduction surgery is performed as an outpatient procedure under local anesthesia with optional intravenous sedation, if requested.
Individuals with abnormal nipple discharge may require screening for breast cancer prior to surgery.
The areola and/or nipple diameter will be reduced to an appropriate diameter that is proportionate with the underlying breast mound (in females), or with normative population measurements (in males). The scars are normally well-concealed.
There are many possible techniques for areola reduction. The technique chosen is dependent on the severity, the desired final areola size and the individual’s expectations. Local anesthesia is injected into the area and the excess areola is excised. Special techniques are used for wound closure to minimize scarring to produce an optimal postoperative appearance.
Many individuals are able to return to normal activities immediately following surgery. Minor bruising and swelling is expected, and will mostly resolve by the 5th postoperative day. Mild disturbances to the nipple sensation may occur but are temporary.
Showering is possible from the 2nd postoperative day onwards. Stitch removal is usually performed on the 10th postoperative day.
