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Are your nipples letting your breasts down?

Posted on Wednesday, 30 January 2019

Surgery options to correct nipples

Nipples come in all shapes, sizes and colours. While the majority of us won’t have spent much time pondering them, according to Specialist Plastic Surgeon, Dr Rohit Kumar from Sydney Cosmetic Sanctuary, the shape and size of a woman’s nipples can have a significant impact to the overall aesthetic of a breast.

Inverted nipples

Hands down, the most common treatment to fix the appearance of a woman’s nipples is the correction of inverted nipples. Inverted nipples, which affect around 20 per cent of women, is when the nipple is flat or concave and refuses to protrude or become erect on its own.

This condition may present early in childhood, during breast development in adolescence or appear later in adult life. In some women, inverted nipples result from the changes that occur as breast tissue diminishes after breastfeeding. In rare instances, this may be caused by underlying breast cancer.

Inverted nipples are due to scarring around milk ducts or shortening of the milk ducts themselves, which pass through the breast and open into the top of the nipples. Inverted nipples can range from mild to more severe degrees of nipple inversion. Surgical correction involves a procedure to release the underlying tissues and may require transection of milk ducts, which could potentially limit a woman’s ability to breastfeed. Surgery is performed under local anaesthesia or with IV sedation and also under general anaesthetic when required. The results are immediate and patient satisfaction high. The procedure may be combined with other aesthetic surgical procedures on the breast.

Asymmetrical nipples

At the top of patients wish list is having a symmetrical pair of nipples. And this is by no means an easy feat, as just like their nipples, most women don’t have symmetrical breasts either. I often explain to my patients — “they are sisters, not twins!”

In mild cases of breast asymmetry, only the pigmented areolas are involved. Most often, there is a slight difference in diameter or shape of the areola, such as an oval or teardrop shape rather than round. Surgical correction of the areola involves removing some of the skin adjacent to or within the pigmented areola and suturing it to provide better cosmetic result and symmetry. For patients who seek areolar reduction or enlargement, centred circles may be used to define the areola at the desired circumference.

Women who undergo breast lift or breast reduction surgery will also benefit from repositioning the nipples to a more aesthetically pleasing level, which is part of the surgical procedure. In these operations, the incision used to lift the nipples may also serve to achieve changes in circumference and shape of the areola.

Tuberous breasts

In women who have tuberous breasts, a condition in which the breast tissue is constricted, the areolas appear significantly enlarged and somewhat distorted relative to the amount of breast tissue and breast skin. In these patients, and depending on considerations such as specifics of the deformity and degree of symmetry, surgical intervention to produce the best cosmetic result involves reduction of the areola in combination with a breast lift or breast augmentation with implants.

There are a few methods that we can use, however, to help create an aesthetically pleasing result for patients and one trick is to decrease the size of long and prominent nipples and reduce the size of the areola as necessary.

When we recreate the nipple and areola, we aim for an area of between 38 to 42mm in diameter and a nipple of approximately 1cm in projection. For the majority of patients, this will deliver an aesthetically pleasing result.

Nipple lift for low hanging nipples

Clinically referred to as ptosis, this is when the position of a woman’s nipples are too low. This appearance is often seen in patients with enlarged breasts or may develop with time as the skin ages, and the nipples appear to hang lower or point downward.

Nipple ptosis correction lifts the nipples into a more aesthetic position. It can also be used to reposition nipples that are too widely or too narrowly set apart. A nipple lift is part of both a breast lift and breast reduction surgery, which are procedures that correct hanging breasts and enlarged breasts, respectively. In patients with small breasts and only a small degree of ptosis, increasing breast volume with implants often produces a small degree of nipple lift and does not require a separate procedure.

Any surgical procedure that involves moving the nipple will produce a scar around the circumference of the areola. During surgery, preserving the nerves and blood vessels that supply the nipples and the ducts through the breast is essential to maintain nipple sensation and breastfeeding ability. Nipple lift surgery may be required in either one or both breasts and yields immediate results in improving symmetry in patients whose nipples are at different levels.

Nipple reduction for enlarged nipples

Enlarged, hanging, downward-pointing nipples often occur in women after breastfeeding as a result of repetitive suction created by the baby while nursing, but they may also be a normal variant of breast development regardless of overall breast size. Patients who seek nipple reduction for unusually large nipples, called hypertrophic nipples, are usually concerned about the prominence of the nipples, which can make them too conspicuous or unsightly under clothing. In addition, nipple hypertrophy may lead to chafing and irritation from constant rubbing against clothes, which can cause further discomfort.

Nipple hypertrophy may be corrected surgically by a number of techniques and results in a smaller, less pendulous, more attractive nipple. In cases where only one nipple is enlarged, nipple reduction of the larger nipple can improve symmetry of the nipples. Further, irregularly shaped nipples can be surgically corrected to appear rounder and more symmetric. Nipple reduction surgery may be performed as a standalone surgery under local anaesthesia with minimal downtime, or concurrently with other types of cosmetic breast surgery such as breast augmentation, breast lift and breast reduction.

Areola pigmentation

Areola pigmentation is typically the final step in the breast reconstruction process, and it is often a very beneficial step because it is the finishing touch on re-creating the appearance of the breasts.

There are different variations on the pigmentation procedure – many surgeons perform skin grafts to achieve the pigmentation effect.

Some practices may also offer tattooing of the pigment. Essentially a medical tattoo – in fact, the procedure is often called “nipple tattooing.” The “tattooing” process has many advantages over other forms of the pigmentation procedure. It’s a simple procedure, satisfaction is high, there are no new scars and, if necessary, the procedure can be repeated relatively easily.

So as you can see, there are a wide variety of issues that can plague the nipple area. But with the surgical expertise of a Specialist Plastic Surgeon, the creation of an aesthetically pleasing nipple which may then flow on to an aesthetically pleasing breast can be achieved.

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