Cosmetic breast surgery isn’t only about augmentation. My downtown Toronto and Richmond Hill locations are seeing an increasing number of patients interested in rejuvenating their nipples and, in some cases, their areolae.
We all know what a nipple is but the areola is the browner disk around the nipple that both men and women have. A study done in the 70’s established that a sexy youthful woman areola (according the a group of males being interviewed) should be 4,2cm in diameter. This number seems to apply across all cultures. A male areola is smaller, averaging 22-26 mm in diameter; the male areola is also slightly ovoid as opposed to a woman’s areola being rounder. Those areolar size numbers are important also when I perform top surgery (gender reassignment) on my trans-male patients where a female-sized areola has to be sized down to a male-size areola.
A large areola is usually present with larger breasts. An areola will also enlarge with pregnancy and breast-feeding.
Nipple piercing and nipple manipulation can also lead to larger nipples.
Finally, nipple piercings leave a permanent tract so patients who are no longer interested in the piercing will also seek a nipple repair. Same applies to other piercings such as belly-button piercing, lip piercing, eyebrow piercing, etc.
Nipple reduction is relatively simple and usually done under local anesthesia. One can wish for a reduction in projection and/or a reduction in the diameter of the nipple. I use both dissolvable sutures and sutures that need to be removed 5-7 days later. Nipple surgery can also be performed at the time of breast augmentation. Recovery is easy as there is no real downtime; patients can return to work right away.
Nipple augmentation is also an increasing request. I perform nipple augmentation with fillers, such as restylane, perlane and the newest juvederm fillers: Volbella, Volift and Voluma. Cartilage graft, dermis graft and bone grafts can also be used.
An areolar reduction can also be performed under local anesthesia. An areolar reduction is also almost always done when performing a breast reduction and a breast lift, aka mastopexy. Areolar reduction is performed by the excision of a donut-like rim of skin with the excess areola and closing back the outer circle to the smaller 4,2cm inner areolar circle. Multiple layers of sutures are required and I commonly use a purse-string permanent suture technique to help preventing future widening of the areola. Resulting scar is at the perimeter of the newly sized areola and usually become a pale scar over one year. Light-coloured scar can later be tattooed with skin-coloured tones.
Recovery for isolated areolar reduction is also simple and relatively easy. Stitches are present for about one week. Patients can normally return to work the following day and I apply a water-tight dressing so patients can have showers and return to work.
Inverted nipple is also a common request at Visage Clinic. Correction of the inverted nipple is also a relatively simple procedure, done under local anesthesia. Various degree of severity – or grade – of nipple inversion exist. The cause of inverted nipple is usually short and tight breast ducts (man en woman have between 15-25 breast ducts). Various techniques exist but the release of the breast ducts is important, along with the closure of the dead space created by the release of breast ducts. Nipple suspension is also considered at the time of inverted nipple repair.
Cost for those procedures varies slightly depending on the request and the technique chosen. Not all surgeons were created equal… make sure your surgeon is a board-certified plastic surgeon – and an artist!
By Dr. Marc DuPere