Cosmetic breast surgery isn’t only about breast augmentation. My downtown Toronto locations are seeing an increasing number of patients interested in rejuvenating their nipples and, in some cases, their areolae.
What makes an areola sexy?
We all know what a nipple is, but you may not know the areola is the browner disk around the nipple that both men and women have. A study done in the 70’s established that for women a sexy youthful 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.
What makes the areola larger?
There are a variety of reasons women and men have large areolae, including:
- Larger breasts usually have large areolae.
- Pregnancy and breastfeeding can make the areolae larger and darker.
- 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, and eyebrow piercing.
How is nipple/areola surgery performed?
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 to 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 a more popular request. I perform nipple augmentation with fillers, such as Restylane®, Perlane®, and the newest JUVÉDERM® fillers: VOLBELLA®, VOLIFT®, and VOLUMA®. Cartilage graft, dermis graf, and bone grafts can also be used.
Areolar reduction can also be performed under local anesthesia. This procedure is also almost always done as part of a breast reduction and a breast lift. 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. The light-coloured scar can later be tattooed with skin-coloured tones.
Recovery for isolated areolar reduction is also simple and relatively easy. Stitches are removed after about one week. Patients can normally return to work the following day and I apply a water-tight dressing so patients can have showers.
It is also common to combine nipple and areola surgery with breast surgery and with a tummy tuck; this combination procedure is often called a mommy makeover or the yummy mummy procedure.
Inverted nipple correction is also a common request at Visage Clinic. Correction of the inverted nipple is also a relatively simple procedure, done under local anesthesia. Various degrees of severity – or grade – of nipple inversions exist. The cause of inverted nipple is usually short and tight breast ducts (man and woman have between 15 to 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.
How much does nipple surgery cost?
Cost for nipple procedures at my Toronto centre varies slightly depending on the request and the technique chosen. Not all surgeons were created equally… make sure your surgeon is a board-certified plastic surgeon – and an artist!
Visit my online patient photo gallery to see my breast lift results, many of which include nipple reduction.
By Dr. Marc DuPere
