Nipple & Areola FAQ

Size and Shape

Does the nipple/areola complex come in an average size or is there an aesthetic ideal?
A wide variety of areolar sizes exist. After reduction surgery, the new areolar diameter is generally set somewhere between 38-48mm, although this can be adjusted based on your goals and the aesthetic opinion of the surgeon. To get an idea of the wide variation in appearance of normal nipples and areolas, visit our nipple gallery.

Does the composition of the breast or the opinion of the plastic surgeon decide the size of the nipple/areola complex after breast reduction or breast lift surgery?
As mentioned above, the areolar diameter is set by the surgeon to best match the overall breast mound. If the areola is already smaller than 48mm, the entire areola is usually saved. If the areola is much larger than 48mm, the excess is usually trimmed. The surgeon may vary the size of the areola based on aesthetics and patient preferences.

Is the size of the nipple changed during breast surgery? Either reduced or augmented depending on your procedure?
The nipple itself (as opposed to the areola) generally remains the same size and shape after surgery.

How is an areola reduction done?
Basically, a circle is drawn on the areola with the nipple as its center. An incision is made on this line, and all areolar tissue outside the line is removed (deepithelialized) so that the new areolar edge can be sewn to the skin edges. Learn more about areola reduction.

How is a nipple reduction done?
There are multiple techniques described to reduce the length and diameters of the nipples. In general, a portion of nipple skin is removed while the deeper structures (milk ducts, nerves, etc) are left intact. Learn more about nipple reduction.

Is it possible for the areola to spread or stretch after breast surgery? If so, what is done to fix it?
For any surgical site there is always a risk of widened scarring, and the areola is no exception. In general, periareolar scars tend to blend nicely due to the natural contrast of breast and areolar pigments. When widened scarring or stretching occurs, a revision of the scar can be performed. Sometimes, a permanent “purse-string” stitch can be placed to keep the breast skin around the areola from stretching the diameter of the areola. This is rarely necessary with primary breast reductions or breast lifts.

Can you repair inverted nipples during breast surgery?
Although this is a separate procedure, a nipple inversion repair can usually be performed safely at the same time as a breast reduction / breast lift / breast augmentation. If there is any doubt about the blood supply to the nipple or areola at the end of the breast surgery, the nipple repair should be performed at a later date. Learn more about nipple repair.

Can the patient have any input into the size and placement of her nipple/areola complex?

Yes. The sizing and placement of the nipple and areola complex is based on multiple surgical measurements of the breast as well as on established aesthetic ideals. From prior experience, these measurements tend to give the best overall results. These ideals can be adjusted to a certain degree if a patient feels strongly about areolar size or positioning.

When having a liposuction-only breast reduction, does the nipple/areola complex reduce in size itself? If it does not, how is it fixed?
Unlike standard breast reduction, liposuction of the breast does not alter the breasts’ overall shape. Rather, it tends to reduce the weight and size of the breast. Likewise, although the areola may decrease in diameter proportionately with the decrease in breast size, it is not reduced or repositioned as it is in standard breast reduction. Only techniques that involve skin removal can dramatically change areolar size.

Is a stretched out nipple/areola complex caused by the weight of the breast or by genetics?
A “stretched out” nipple/areola can be caused by multiple factors including genetics, mechanical forces of the weight of a breast, the elasticity of the skin, age, etc.

How small can the nipple/areola complex be made and still maintain viability?
There is no real limit of areolar reduction in terms of viability, however, excessive reduction of the areola produces a disproportionate, unaesthetic appearance.

Does the age of the patient have anything to do with the placement of the nipple/areola complex?
No. The placement of the nipple/areola complex is usually based on the location of the inframammary fold (the fold under the breast). The location of this fold does not change much with age, although the overlying breast tissue can change significantly.

Why is there a difference between the sizes of the nipple/areola complex when it’s “at rest” versus stimulated?
Smooth muscle fibers in the nipple/areola can contract and thus reduce its size when stimulated.

Should the nipple/areola complex be placed so that it’s facing perfectly forward or should it placed off to the side slightly?
The nipple/areola is generally placed so it is facing forward. However, it should also be centered on the breast mound, so depending on the shape of the chest, the nipple/areola may look better if it is not “perfectly forward.”

If a patient is having a revision to correct the size of the breast after breast reduction, can she also have the size of the nipple/areola complex reduced?
Yes.


Color

Does your nipple/areola complex always lose color with breast surgery?
Different people have different responses to surgery. Often, the color remains the same, however, darkening or lightening of the pigment can also occur.


Feeling

How common is loss of sensation after breast surgery?
Most women will have temporary numbness (partial or complete) immediately after surgery. In most cases the sensation returns over time.

How common is nipple hypersensitivity after breast surgery?
Nipple hypersensitivity is much less common than numbness.

What is the best way to deal with nipple hypersensitivity after surgery? Is there a safe and common remedy?
Usually this hypersensitivity will resolve over time. Care should be taken to keep the nipple/areola moisturized and protected from rubbing by clothes. Gentle stimulation on a frequent basis can also help to desensitize the nipple/areola.

How long after breast surgery before you can expect to regain nipple sensation?
Every woman is different. Expect at least a few weeks, although it can take months or longer in certain cases.

Immediately following breast surgery, is it painful if your nipples get hard?
This is not a common complaint.

Is it normal to have sensation in my nipple but not my areola after breast surgery?
Everyone recovers differently, and different women will experience alternate patterns of sensation during recovery. Usually both nipple and areola sensation will return over time.

Why do some women have more sensation in their nipple/areola complex after breast reduction surgery?
Sometimes, the weight of the breast is such that the nerves are stretched by the hanging tissue. In some cases, once a reduction is performed, patients will note improved sensation compared to their preoperative sensation. Also, the generalized inflammation from healing can sometimes cause hypersensitiviy.

If the nipple/areola complex remains hypersensitive for a long period of time post op (i.e. a year) is there something that can be done to stop the hypersensitivity?
In rare cases patients will ask for surgical division of the nerves to their nipples.


Post Op Appearance

After breast reduction some patient’s nipples look as though they are not well attached and ready to fall off the breast. Why is that and is it common?
Unless you undergo a “free nipple graft” which involves complete removal of the nipple/areola and reattachment as a skin graft (usually reserved for extremely large reductions), the nipple and areola should be well attached to the underlying tissue. There may be an illusion of the nipple “falling off” if the wound edges separate, or if there is significant swelling in the areola relative to the breast tissue.

Why does the nipple/areola complex “puff” out after breast reduction surgery? How long does this last? Is there anything that can be done to prevent it?
If this happens, it is usually from local swelling which resolves over time. There is nothing outside of the standard postoperative care that needs to be done.

Why does the nipple/areola complex sometimes not appear to be properly placed on the breast after surgery? Will they return to their proper position?
Some asymmetry may be due to different degrees of swelling in the right versus the left breast. If this is the case, it should improve over time.

My nipples react differently to stimuli after breast surgery. Will they react at the same time (i.e. getting erect) at the same time in the future? If so, how far in the future?
Just as different women react to surgery differently, each breast can have its own recovery pattern. There is no way to predict the timing of this recovery, however the healing process usually “evens out” over time.

My nipple/areola complex appears different on each breast following surgery, will this resolve? How long should it take?
Most women have breast asymmetry preoperatively, and there is often some asymmetry after breast surgery as well. Sometimes it may be due to swelling or other processes that resolve over time. Sometimes scarring or other issues can result in asymmetry that does not resolve. If the asymmetry is substantial after healing is completed, surgical revision may be needed.

Is it normal to have constantly erect nipples after breast surgery? Can anything be done to prevent it?
This would be an unusual situation, and would be treated in a similar fashion to people with hypersensitive nipples — protect the tissues from being rubbed excessively by clothes, and wait for the issue to resolve over time.


Post Op Care

Should ice or heat ever be applied to the nipple/areola complex after breast surgery? Why or why not?
Due to potential injury, heat should never be used. In rare cases, icing may be used. Cool compresses are frequently recommended. You should discuss specifics with your surgeon or nurse, as different physicians have varying protocols.

How do I know the difference between normal healing discomfort and the discomfort that comes from a complication in the making?
In general, if you experience progressively worsening pain during the healing process, especially when combined with new fevers, drainage or redness of the skin, you should contact your surgeon. General soreness that is improving over time, on the other hand, is usually normal.

After breast surgery my nipple/areola complex is dry and flaky. Is there a safe treatment for this?
After the wounds have started to heal, a gentle moisturizer can be effective to prevent dryness.


Complications

What is the main reason women lose one or both nipples after breast surgery?
If the blood supply to the soft tissues underlying the nipple/areola is compromised, partial or complete loss of the nipple/areola is possible. Cigarette smoking will also greatly increase the risk of nipple/areola loss.

Do spitting stitches on the incisions around the nipple/areola complex cause more noticeable scars?
Usually not, unless there is a significant infection with a large wound (rare). If necessary, later scar revision can minimize any postoperative scars.

Is there increased risk of nipple/areola complex loss when a revision is needed? If so, why?
The risk is usually low for any minor revisions. If a complete redo of the reduction is performed, the surgeon must know where the blood supply was based during the previous surgery so he or she can preserve the same blood supply “pedicle.” Otherwise, there is a significantly higher risk of nipple/areolar loss.

If a revision surgery is, in essence, doing the entire breast reduction over again will the nipple/areola complex be made smaller still because of the additional cutting and suturing?
The nipple/areola complex size does not need to be changed with the second surgery unless it would be an aesthetic improvement.

If there are complications with the blood supply to the nipple/areola complex during surgery, is it possible for just the nipple to die? Or just the areola to die? Or is it always the entire nipple/areola complex?
Obviously, this is a very rare complication. Depending on the severity of the problem with blood supply to the nipple/areola, part or all of the complex can die. Which parts, specifically, can vary greatly from patient to patient.


Miscellaneous

If the nipple/areola complex has hair either on it or around the outside edge, can that be removed during my breast reduction surgery?
Yes, if the hair is at the edge of the areola, it is often removed with the reduction.

If I lose nipple sensation after my breast surgery does that affect my ability to breast feed?
Studies performed regarding breast feeding after breast reduction have shown little to no problems. Only about 70% of the general female population is able to breast feed effectively, and breast reduction may lower this possibility to around 60%. There are multiple other triggers to the let-down of breast milk besides direct nipple stimulation.

After 2 ½ months post op the previously flat scars around my nipple/areola complex are now raised and noticeable through my shirt. What caused this and what can be done to correct it?
Some women are prone to “hypertrophic scarring,” and can develop raised and red looking scars during the healing process. Frequent scar massage (once the acute wounds are healed) can help to flatten and smooth out the collagen in the scars. Also, it can take 6-12 months for the scars to mature completely and for the redness to fade. Occasionally, silicone sheeting or steroid injections are used to improve scar appearance. On rare occasions, surgical scar revision must be performed.

What are inverted nipples? Why do some women have inverted nipples?
Approximately 2% of women have at least one inverted nipple. This is a situation where a person’s nipple is pointed inward (an “innie” rather than an “outie”). The inversion can be seen in varying degrees of severity. Often, this condition is congenital and due to tethering of the shortened underlying structures (milk ducts) of the nipple. Sometimes scar tissue underneath the nipple from prior surgery or infections can cause inversion as well.

Can inverted nipples be repaired, how?
Inverted nipples can be repaired with a surgical release of the tethering structures, and some type of suturing technique to maintain the nipples in an outward position. There are multiple variations of this repair.

If a woman’s nipples are inverted, do they need to be repaired?
There are no significant health issues with nipple inversion. Nipple inversion can make breast feeding difficult or impossible, and is often an aesthetic concern for patients. These are frequent reasons why patients seek repair.

What is the purpose and function of the areola?
The areola helps to support the nipple and also contains Montgomery’s glands which help to keep the nipple moisturized during breastfeeding.

Why is the color of the nipple/areola complex darker then the rest of the breast?
Most people have more pigment-containing cells in their areolas than the surrounding breast skin, causing a darker coloration.

Why is the color of my nipple/areola complex not different in color from the rest of my breast?
There is a wide variety of areolar colors, and some are distinctly different from the breast skin, while others are more similar or nearly identical in color to the breast skin. These are all normal variations.

How common is the nipple reduction procedure?
Nipple (as opposed to areola) reduction is fairly rare. Some women are unhappy with the length or diameters of their nipples. If this is a problem, the nipple size/length can be reduced surgically.

Are there guidelines as to what size the nipples should be before being considered for nipple reduction?
There are no set guidelines, however, most surgeons would not recommend nipple reduction unless the nipples are particularly large, tender, or cause problems with wearing certain clothes.

How soon after my breast surgery can I get my nipples pierced?
It is advisable to wait until healing is nearly complete to minimize chances of infection or hampering the nipple’s blood supply. This usually amounts to 3-6 months after surgery.

How does breast reduction change the function of the Montgomery’s glands? Are they removed during surgery?
Montgomery’s glands are modified sweat glands which produce secretions that act as a lubricant for breastfeeding. In most cases, Montgomery’s glands (the bumps on the periphery of the areola) are removed with reduction of the areola during breast reduction. They should continue to function in their usual fashion if they are left in place.

In breast augmentation, how popular is the nipple incision method? Not the periareolar incision, but an incision that goes around the nipple?
The usual approaches to augmentation are periareolar incisions, inframammary incisions, axillary (armpit) incisions, and less commonly trans-umbilical (through the bellybutton) incisions. An alternate technique uses an incision that cuts across the areola, coursing around the underside of the nipple. This technique tends to cause problems with pigment change and numbness, and is therefore rarely used.

Plan to come in and talk with One of our Los Angeles cosmetic surgeons soon. Dr. Stevens or Dr. Spring will be happy to spend time educating you and helping you decide which breast procedure is right for you. Just go Inside Online to request a consultation. Free appointments are available at select times.


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