There is a lot of buzz in the plastic surgery world about breast surgery, but little discussion of a key element of a beautiful, natural breast: the nipple-areolar complex. Thanks to genetics, aging, or changes related to pregnancy, the nipples and areolas can present with many anatomical variations, such as inversion or a “puffy” appearance, that can only be addressed by a plastic surgeon. Luckily, many of these corrections can be performed in-office under local anesthesia for a shorter recovery.
Below, Honolulu plastic surgeon Dr. Larry Schlesinger explains all of the nipple reshaping surgeries he performs.
You may wonder, how can surgery fix puffy nipples? This is an uncommon nipple revision surgery, and for good reason: the technique for correcting this issue is not well-known. For many years now, I have used a suture technique that anchors the tissue of the areola (the circular pigmented area surrounding the nipple) to the underlying layers of skin with dual-directional sutures.
My patients see excellent, long-lasting results with this procedure to flatten puffy nipples. This technique is relatively straightforward and quick, and can be performed under local anesthesia here in my Honolulu office.
While addressing herniated nipples themselves requires only a simple procedure, puffy nipples are often part of a larger issue: tuberous breast deformity. Also known as “snoopy” breasts, tuberous breast tissue is constricted as it develops during puberty and requires a different approach (occasionally performed in multiple phases) to restore a full, natural shape to the breast tissue. Learn more about tuberous breasts and how a plastic surgeon can address them »
Inverted, or retracted, nipples are caused by tight breast ducts that pull the nipple and areola back into the breast. Nipples can become inverted after infections during breastfeeding that leave scar tissue on the milk ducts, or this condition can simply be genetic.
If you do not plan to breastfeed in the future, we can address inverted nipples in a two-step procedure. First, the ducts are separated from the nipple to allow the nipples and areolas to relax slightly. Second, to gently stretch the skin toward a natural, round nipple appearance, we will pierce the nipple using a dumbbell. As the piercing heals, the body deposits collagen beneath the skin, helping to permanently hold the nipple in a more natural-looking shape.
Hypertrophic nipples, which are especially common after breastfeeding, protrude and may be visible under clothes or simply uncomfortable. To address this, we can remove excess, stretched nipple tissue to recreate a flatter, more natural-looking nipple-areola complex. This technique requires two shallow circular incisions within the areola.
Nipples may develop a downward-facing, bent shape during breastfeeding, despite sitting in an ideal position on the breast. The nipples can be returned to a front-facing position by removing excess tissue through a small, crescent moon-shaped incision placed along the upper edge of the areola.
Areola reduction surgery is commonly performed as part of a breast lift, using the same incisions needed to lift a sagging or ptotic breast. To address wide areolas alone, incisions are placed around the circumference of the areola. The size reduction will leave visible scars around the areolas, but over time (with proper care) these can fade until they appear to be a natural part of the areola’s perimeter.
Yes, men have many of the same complaints about their nipples that women do and may also benefit from a nipple correction surgery (which can often be performed in our office under local anesthesia). Many men also struggle with gynecomastia, or enlarged male breasts, which can be corrected with gynecomastia surgery. Gynecomastia correction can be combined with nipple revision surgery for inverted nipples, wide areolas, or other concerns that men have.
Yes, it is possible to perform nipple correction in the same procedure as a breast lift, breast augmentation, or breast reduction. The specific details of your procedure will vary based on your individual anatomy and the techniques that I recommend to achieve your goals.
Dr. S. Larry Schlesinger is a highly regarded breast surgeon with decades of experience and refined techniques backed by research and experience. He is also a leading expert in tuberous breast surgery. To schedule your consultation in Honolulu, call our office today at 808.597.8835 or reach out to us online.