Nipple Surgery

Every woman’s and man’s nipples are different. Some common conditions that people may wish to correct through surgery include reducing naturally large areolas or inverted nipples. These procedures can be done in conjunction with other breast surgeries such as a breast lift or breast augmentation.

Areola Reduction Surgery

The areola (areola mammae) is the circular pigmented area surrounding the nipple (papilla mammae) and its surface is dotted with little projections due to the presence of areolar glands (sebaceous glands that secrete a waxy, lipoid fluid to lubricate moisturise and protect the areola and the nipple) beneath.

Enlarged areolas can be both unflattering and a source of personal insecurity and may develop due to age, genetic predisposition, stretching of tissue by heavy breasts, or pregnancy and breast-feeding.

Areola Reduction surgery is designed to remove the redundant areola tissue and improve the overall cosmetic appearance. It is performed by removing some of the pigmented area. The procedure involves either an incision around the outside of the areola or a smaller incision with removal of the excess tissue in between like a donut, or by an incision around the base of the nipple. Very large areolas may require a lollypop-shaped closure. This is where a vertical incision runs down from the nipple as well as around the areola and then closed in the shape of a lollypop. Dissolvable sutures are placed underneath the skin, which help to minimise scarring. The resulting scars are well positioned around the outer edge of the reshaped and resized areola and are virtually invisible. Areola Reduction is often performed at the same time as a breast lift or breast reduction.

Diagram: Nipple Reconstruction, CV Flap

The procedure takes 1-2 hours and is performed under general anaesthesia. Dressings will need to be worn for a week. There may be minimal pain and swelling which usually dissipates by the second or third day and is easily controlled by medications. Recovery time will depend on the patient, but most patients can return to work and resume their normal activity within two days. The pleasing result of Areola Reduction surgery is a balanced and proportioned size and shape of the nipple-areolae complex.

Inverted Nipple Correction

Inverted nipples, or nipple inversion, occur in about 2% of women. Inverted nipples are usually evident as a slit or hole in the breast at the location of the nipple and may be present on one or both sides. Inverted nipples are usually a congenital problem 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 and 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.

There are two techniques to correct inverted nipples - one that leaves the milk ducts intact and one where the milk ducts need to be divided. In either case, the objective is to reshape the nipple and areola so that the nipple projects out from the breast, enhancing the appearance of the breast while preserving sensitivity of the nipple. The technique that leaves the milk ducts intact can also help preserve a woman's ability to breastfeed.

Milk Ducts Intact

An incision will be made just around the base of the nipple on the areola. The nipple and areola tissue is lifted from (but still connected to) the breast and stitched into a new, projecting shape utilising a purse-string style of suturing (stitches). Because of the circular shape of the scar around the nipple, scar contracture will actually increase rather than decrease nipple projection. Because the milk duct tethering is often the cause of inverted nipples, this method has a significantly higher recurrence and relapse rate.

Milk Ducts Divided

This procedure is much more common and may be necessary in more difficult cases. An incision is made at the nipple base, and the shortened milk ducts are detached, allowing a natural-looking projection of the nipple. The incision is sutured closed and medicated gauze is applied to the site.

Recovery is very rapid with a return to work and most activities within hours. Showers are permitted the next day. The sutures will be removed in 14-21 days. There is minimal pain or swelling. Sensation is normal immediately or returns fully within several days. You will be required to wear a foamy protective dressing for a minimum of 4 weeks to minimise recurrence or flattening or your newly everted nipples.

Nipple Reconstruction

Nipple reconstruction can be performed in two main methods:

  1. The two-staged reconstruction where firstly, a nubbin is made on the reconstructed breast mound, then the area is tattooed to recreate the areola.
  2. Nipple-sharing technique, where the opposite areolar and nipple is used as a graft to create a nipple on the reconstruction side. This often requires a large nipple-areola complex on the normal side. It also has the disadvantage of creating scars on the donor breast.

Dr Vrtik most commonly use the former method for nipple reconstruction. This is a procedure that can be performed as early as 3 months after breast reconstruction. It is not an operation wanted by everyone who has had a breast reconstruction. The decision to have a nipple made is very much a personal choice.

This procedure can be performed either under a general anaesthetic or a local anaesthetic with intravenous sedation as a day-surgery admission. The nubbin for the nipple is made with skin flaps raised from the local tissues, and wrapped and sutured to create height and projection. This is then dressed with gauze, protective foam and tape. Sutures are removed at two weeks. You will be required to continue to wear the protective foam for 6 weeks to prevent flattening of the nubbins by clothing and pressure. At the six- week review, if the wound has healed and scars have softened, you will be referred to a medical tattooist to recreate the colour for the new areola and match the appearance of your natural areola.

The cost of nipple reconstruction is covered by most private health insurance. However, medical tattooing of the areola is not, although some medicare rebate may be claimable.

The result of nipple reconstruction is long lasting. There is always at least 30% reduction in the nipple height and projection when swelling subsides at 6 weeks. Once created, a reconstructed nipple often signifies the end of many women’s reconstructive journey and allows some breast cancer women to relinquish their sense of loss.

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