Nipple Reduction

There are three main nipple and areola conditions treated by nipple surgery:

• Nipple Reduction is carried out to reduce the height and width of the nipple whilst preserving its sensation a can be very effective at relieving embarrassment associated with this condition. It can be carried out under local anaesthetic as treatment as well as recovery is quick and straightforward.
• Areola Reduction is a swift and straightforward procedure that removes the excess brown area from around the nipple. Small reductions leave an inconspicuous scar around the base of the nipple. Larger reductions can leave a scar around the outside edge of the areola – both techniques can be carried out under local anaesthesia.
• Nipple Inversion is when the nipple itself lies flat or inverts inwards towards the body rather than protruding in the normal way. This condition can occur from birth but in some cases, can develop later on in life. This is typically another swift and straightforward procedure that can be carried out under a local anaesthetic although different grades of inverted nipples require different complexities of surgery.

Each of these surgical procedures is straightforward and can either be carried out on their own under a local anaesthetic or as part of a more complex breast procedure.

Areola reduction surgery refers to any nipple reduction surgery that specifically relates to the changing of the size or shape of the areola region around the nipple.

The dark skin area around your nipples is called the areola. If you feel this area is too large you may be a candidate for areola reduction surgery.

Areola reduction surgery is performed by removing a circular area of the outer brown area of the areola to reduce it in size.

Areola reduction is usually performed under local anaesthetic and takes about one hour. In some rare cases, general anaesthetic may be used.

There surgical techniques associated with the various nipple conditions vary slightly from one another:

• Nipple Reduction – the most popular involves elimination of a strip of skin about the neck of the nipple which is closed and sutured reducing the height of the nipple by pushing a portion of the nipple back into the breast tissue. This is a very straightforward procedure and is often performed under local anaesthetic.
• Areola Reduction - Areola reduction is a quick and simple procedure that can be performed on both men and women. It involves removing the excess brown or pink area surrounding the nipple which usually has a diameter of between 4-5cm. Areola reduction usually begins with your surgeon removing a circular segment of the outer brown area of the areola. The skin surrounding this is then brought inwards in a purse string fashion to surround the areola.
• Nipple Inversion surgery is usually carried out under local anaesthetic and in one of two most common ways. The first begins with an incision to allow lifting of the nipple and areola tissue whilst remaining attached to the breast, the ducts are separated and the nipple is allowed to sit proudly in its new position. The second method is the incision is made at the base of the nipple and the shortened milk ducts are detached completely allowing for a natural looking projection of the nipple.

Nipple size or appearance can often change through weight gain, weight loss or pregnancy but can also be caused by hormonal imbalances and genetics. Conditions such as gynaecomastia can also cause nipples to appear oversized in proportion to the rest of the chest.

Nipple surgery will be performed by one of our highly trained plastic surgeons.

Your nipple (and/or areola) reduction consultation will also be an opportunity for you to ask the surgeon about anything you are uncertain of.

Some things you might want to ask may include:

• Are my expectations realistic for nipple surgery?
• Do you have any before and after pictures of previous nipple reduction surgeries?
• Where will the scars be and how will you minimize them?
• How long is the recovery period?
• Will my nipples be sore after surgery?
• How soon until I can see the final results?

Nipple reduction surgery is normally performed under local anaesthetic which means you are awake during the operation.

If you would prefer your nipple reduction surgery to be performed under a light general anaesthetic, this can be arranged with your surgeon prior to surgery.

The reason nipple reduction takes place under local anaesthetic is that it is a very quick and straightforward procedure that takes around 20 minutes to treat each nipple. The procedure involves the excision of the nipple tissue to reduce its size; the scars post-surgery will be minimal and virtually undetectable as they are well hidden on the underside of the nipple where it meets the areola.

During your consultation, you can expect your surgeon to examine your breasts, go over your surgical options and ask you for a complete medical history and current list of medications. Your surgeon will listen to your aesthetic concerns and explain the procedure to you. They will give you an idea of what your areolas and nipples will look like after the surgery.

Your experienced Cadogan Clinic surgeon will give you pre-operative advice at your initial consultation and this may include stopping smoking and taking certain medications such as aspirin which will delay your healing.

Many of these procedures can be easily accomplished under local anaesthesia. For the larger procedures or for preference you may decide to have our gentle form of anaesthesia, TIVA (Total Intravenous anaesthesia) in this case, you'll be asked to arrange a ride to and from the procedure, as you'll be unable to drive after surgery.

You will need to fast for 4 hours, although sips of water are permissible for up to 2 hours before surgery. It's also best to come to surgery without any make-up or cosmetics, without wearing any jewellery and in comfortable, loose fitting clothes.

During your consultation, you can expect your surgeon to examine your breasts, go over your surgical options and ask you for a complete medical history and current list of medications. Your surgeon will listen to your aesthetic concerns and explain the procedure to you. They will give you an idea of what your areolas and nipples will look like after the surgery.

Your experienced Cadogan Clinic surgeon will give you pre-operative advice at your initial consultation and this may include stopping smoking and taking certain medications such as aspirin which will delay your healing.

Many of these procedures can be easily accomplished under local anaesthesia. For the larger procedures or for preference you may decide to have our gentle form of anaesthesia, TIVA (Total Intravenous anaesthesia) in this case, you'll be asked to arrange a ride to and from the procedure, as you'll be unable to drive after surgery.

You will need to fast for 4 hours, although sips of water are permissible for up to 2 hours before surgery. It's also best to come to surgery without any make-up or cosmetics, without wearing any jewellery and in comfortable, loose fitting clothes.

You will start to see an immediate, visible improvement as soon as the stitches are removed in the days after surgery.

You will be able to see your final results and the shape of the nipple and areola within 2-3 months of the procedure, once the areola has settled into its new form and the scar has settled.

Yes your results will be permanent.

This procedure is not particularly painful, and the pain can be managed with over the counter painkillers, such as paracetamol and anti-inflammatory medicine.

Nipple reduction is very safe, minor surgery.

You will need a protective dressing for at least a week following surgery. This can be disguised with loose clothing. There may also be stitches to remove after 7-10 days.

Exercise including brisk walking should be avoided. However, you are not in significant pain and capable of working from home the next day.

Normal work depends on travelling issues and how physical it is. You may need to take one week off work following an areola or nipple reduction/correction surgery, perhaps longer if your job requires anything very physical.

Strenuous activities, heavy lifting and intense exercise should be avoided for around 6 weeks following your surgery.

You should be back to your regular routine and exercise after 4+ weeks of surgery.

Recovery from Nipple Reduction surgery is quick with very little disruption to your normal routine.

You may experience some bruising and swelling in the area operated on, however, this will usually fade in a couple of days.
Our surgeons use very fine stitches that will dissolve and fall out naturally over the course of a week or so. This procedure is not particularly painful, and the pain can be managed with over the counter painkillers, such as paracetamol and anti-inflammatory medicine.

During the healing and recovery process, you should be able to return to your normal daily activities just a few days following your surgery, depending on your tolerance of the swelling. We recommend avoiding any strenuous activities, or heavy lifting, for at least 4 weeks following the surgery. Wearing a good support bra for the weeks following the surgery is also recommended for women.

Scarring post-surgery will be minimal and virtually undetectable as they can be well hidden on the underside of the nipple where it meets the areola.

When the nipple is a different colour than the skin surrounding it, often the scar will blend in and appear more natural.

Our highly skilled surgeons will focus on retaining the connections between the breast tissue and the skin, to preserve the ability to breastfeed

Whilst we are unable to guarantee that you will be able to breastfeed after surgery, it is certainly an aim of your surgeon at the outset.

If you have recently had a baby and are currently breastfeeding, your surgeon may require you to wait for 3 to 6 months before you have a nipple reduction. This is so that your breasts and nipples can settle before the procedure.

Currently, there are no options other than surgery to reduce the size of the nipple or areola, or change nipple or areola shape.

A protruding nipple can be fixed by trimming the skin and bulk of the nipple to shrink its overall size. It is similar to other procedures that remove excess tissue from the body, but in this case, the procedure is on a much smaller scale and scars insignificant.

Around one in ten women in the UK suffer from nipple-related conditions where the nipples may be irregular or enlarged causing them to protrude through clothing. Protrusion can be a source of embarrassment as well as pain and irritation known as 'jogger's nipple'.

Protruding nipples can be an issue for men too. Underlying breast tissue may, in addition, push the nipples outward and require reduction. This condition is called Gynaecomastia.

Nipple correction is about ridding the patient of their social anxiety or embarrassment and physical pain from their condition.
Protruding nipple correction at our Clinic can reduce the height and width of the nipple while still preserving sensation. Nipple correction can easily be combined with other procedures, so you only have to go through the process of surgery once.

If you find your self-image and your confidence comprised by protruding nipples, the solution may be easier than you thought. The procedure is relatively simple and straightforward. It can be carried out under local anaesthesia or in combination with other procedures (under general anaesthesia).

Recovery from protruding nipple surgery is quick with very little disruption to your normal routine. Nipple correction surgery is an outpatient procedure. Since there is no long rest period following the procedure you will be back in the swing of things with newfound confidence in no time.

Puffy nipple is a nipple or areola that forms a puffy nipple mound away from the normal curve of the chest. Puffy nipple can occur in both men and women, but is more common among women. Puffy nipple is also common among teenagers experiencing puberty, as this is a key time of breast development.

Puffy nipple is easily fixed by nipple reduction surgery.

‘Puffy nipple’ can be caused by genetics and hormonal changes, as well as array of external factors including diet, medications or steroid use.

Many symptoms of ‘puffy nipple’ can be reversed by diet and exercise, or stopping the use of certain medications. In many cases, however, the symptoms of ‘puffy nipple’ can only be resolved via puffy nipple reduction surgery.

Inverted nipple is a nipple or areola that forms an inverted nipple mound that points inward or flat from the normal curve of the chest. Inverted nipple can occur in one breast or both. Inverted nipple can occur in both men and women.

Inverted nipple can be classified in three grades:

• Grade 1: the inverted nipple can easily be pulled outwards, and reacts to stimulation
• Grade 2: the inverted nipple can be pulled outward but reverts quickly original shape
• Grade 3: the inverted nipple cannot be pulled outward at all

Inverted nipple reduction surgery is typically necessary in instances of Grade 2 and Grade 3.

‘Inverted nipple’ can be caused by genetics, as well as an array of external factors including age, breast feeding, or injury.

By far the most effective treatment for ‘inverted nipple’ is inverted nipple reduction surgery. Inverted nipple surgery takes less than an hour and takes place under local anaesthetic.

A nipple reduction procedure will solely address problems with the size and shape of the nipple itself, or the surrounding areola (in the case of an areola reduction or correction).

Wider concerns relating to the size and shape of the breast region will need to be addressed via other surgeries. These can be easily be combined with nipple reduction into one larger operation.