Nipple and Areola Surgery: Options and Considerations

The nipples and areolas are important elements of breast aesthetics. Various procedures are available to address concerns about size, shape, position, or appearance of these features—whether as standalone procedures or combined with other breast surgery.

Common Nipple and Areola Concerns

Women seek nipple and areola procedures for various reasons:

Size Concerns

• Areolas that appear disproportionately large
• Nipples that protrude excessively
• Nipples that appear too flat or small

Shape and Position

• Inverted nipples (nipples that point inward)
• Asymmetrical nipples or areolas
• Nipples positioned too high, low, or off-center

Post-Surgical or Post-Trauma

• Following mastectomy and breast reconstruction
• After breast reduction or lift surgery
• Following injury or previous unsuccessful surgery

Areola Reduction

Large areolas can be reduced to better proportion with the breast.

The Procedure

• Performed under local anesthesia (or with other breast surgery)
• Circular incision removes outer portion of areola
• Skin is closed around newly sized areola
• Takes approximately 1 hour as standalone procedure

Recovery

• Minimal downtime
• Most return to work within days
• Avoid strenuous activity for 1-2 weeks
• Final results visible once swelling resolves

Results

• Smaller, more proportionate areolas
• Some scarring around areola edge (typically fades well)
• Permanent results

Inverted Nipple Correction

Inverted nipples occur when milk ducts are too short or tissue is scarred. This can be present from birth or develop over time.

Grades of Inversion

• Grade 1: Nipple can be pulled out and maintains projection temporarily
• Grade 2: Nipple can be pulled out but retracts quickly
• Grade 3: Nipple cannot be pulled out and is severely inverted

Correction Techniques

Technique depends on severity and whether preserving breastfeeding ability is important:

• Preserving ducts: Releases tissue without cutting milk ducts (may allow future breastfeeding)
• Cutting ducts: Provides more reliable correction but prevents breastfeeding

Recovery

• Local anesthesia, outpatient procedure
• Sutures and protective dressing
• Special shield may be worn during healing
• Full healing in 2-4 weeks

Nipple Reduction

For nipples that protrude excessively, reduction can create a more proportionate appearance.

The Procedure

• Performed under local anesthesia
• Excess nipple tissue is removed
• Nipple is sutured to smaller size
• Can address length, width, or both

Considerations

• May affect nipple sensation
• Usually does not affect breastfeeding ability
• Scarring minimal and well-hidden

Nipple Reconstruction After Mastectomy

For women who have undergone breast reconstruction, nipple reconstruction completes the restoration.

Timing

Typically performed 3-4 months after breast mound reconstruction, once the new breast has healed and settled.

Techniques

Surgical Reconstruction

• Local tissue flaps create a three-dimensional nipple
• Can be done in office under local anesthesia
• Creates projecting nipple from existing skin

Tattooing

• Creates realistic appearance of nipple and areola
• Non-surgical option
• Can be done whether or not surgical reconstruction performed
• Performed by specialized medical tattoo artists

Combination Approach

Many women combine surgical reconstruction for projection with tattooing for realistic color and areola appearance.

Nipple and Areola Procedures with Breast Surgery

These procedures are commonly combined with:

Breast Lift

Repositions nipples and often reduces areolas as part of the lift.

Breast Reduction

Typically includes repositioning nipples higher and reducing enlarged areolas.

Augmentation

May be combined with nipple procedures if concerns exist.

Reconstruction

Nipple reconstruction is the final stage of breast reconstruction.

What to Expect from Results

Realistic Expectations

• Improvement in appearance, not perfection
• Some asymmetry is natural and expected
• Scarring occurs but typically fades well
• Sensation may be affected (often returns over time)

Breastfeeding Considerations

Discuss with your surgeon if you plan to breastfeed in the future. Some procedures preserve this ability while others do not.

Choosing a Surgeon

For nipple and areola procedures, seek a surgeon who:

• Is board-certified in plastic surgery
• Has specific experience with these procedures
• Shows before-and-after photos of similar cases
• Explains realistic outcomes
• Discusses preservation of function when relevant

Recovery Guidelines

General Recovery (most nipple/areola procedures)

• Keep area clean and dry
• Wear loose, soft clothing
• Avoid friction on the area
• Follow specific wound care instructions
• Attend all follow-up appointments

Activity Restrictions

• No strenuous exercise for 1-2 weeks
• Avoid sleeping on stomach initially
• Sexual activity restrictions vary—ask your surgeon

Nipple and areola procedures, while often considered "smaller" surgeries, can significantly impact how you feel about your breasts. Whether as standalone procedures or combined with other breast surgery, these options offer solutions for concerns that may have bothered you for years.