I have been doing Nipple Correction surgery in Orange County and Los Angeles for more than 25 years. Nipple surgery includes a number of surgical and nonsurgical procedures for the correction of inverted nipples, areola reduction, nipple enlargement and nipple repair from piercings or traumatic injuries.
Most of these procedures can be done in the office under local anaesthesia with minimal or no down time and quick healing. Any of these procedures may interfere with breast feeding so this must be considered by the patient.
Nipple reduction is requested by both men and women. For women, the most common request is to reduce a nipple that protrudes too far, being too visible with or without clothing. On occasion, the nipple itself can also be too wide in diameter or asymmetric compared to the other side. Men can have a similar problem, or the nipple can be pushed forward by too much gland behind the areola (resulting in “puffy” areolas). The incisions can be done a number of ways but they all work well and are generally invisible or very hard to see.
Inversion can occur with breast development in as many as 2% of women and may be on one or both sides. Sometimes the nipple can be expressed forward. The nipple may come out with cold or conversely the cold can pull the nipple in as the areola contracts. This can also occur after breast feeding problems, infection, trauma, or with breast cancer.
This procedure can be performed in the office under local anesthesia, but it is commonly performed with other breast surgery such as breast augmentation, breast mastopexy, or breast revision surgery.
In severe cases of nipple inversion the breast ducts may need to be severed. Breast feeding can be affected by these procedures so this must be a serious consideration. Devices such as the Niplette by Advent can be used without surgery with some success. It is often used after surgery to create suction and maintain the correction.
For women who have very flat nipples, augmentation can enhance projection. This is a simple procedure that can be performed with a filler such as fat or an HA such as Juvéderm® or similar. Other implants including cartilage or synthetic products can also be used.
The areola may be enlarged with breast development. Conditions such as tuberous breasts frequently have larger areolas. This can also be seen with large breasts, weight gain, asymmetries, pregnancy , and breast feeding.
The reduction generally requires a periareola or “donut-type” excision. Again, this can be done with local anaesthetic in the office. There will initially be some irregularity of the incision with puckering that smoothes over 4 or 5 months. This is the same procedure used for the periareola breast lift or mastopexy.
Both women and men may have “puffy nipples” which will require tightening the areola and sometimes removal of breast tissue from underneath the nipple. Men can also suffer from enlarged or inverted nipples which can be reduced in a similar manner to what has been discussed above.