Nipple & Areola
Surgery

The areola is the flattened area of pigmented skin around the nipple. The nipple and areola complex undergo hormonally driven changes throughout a woman's life at puberty, breast feeding, menopause etc. The complex may also be removed as part of the treatment for breast cancer.

May be as part of a large breast (macromastia), or part of a mal-development of the breast as is seen in tuberous breast deformity. It can also be seen as a complication of prior breast surgery, especially where a donut type technique was used. Various surgical techniques can be used to make the areola diameter smaller (routinely done in a breast reduction and breast lift)

Can be inverted, too broad or too long (or a combination of the latter 2)

Inverted nipples are not uncommon and are usually only repair if fixed (i.e. cannot be brought out manually). Surgery for inverted nipples usually involved small stab incisions at the base of the nipple and then the shortened ducts and fibrous tissue is released. Once achieved, I place a permanent suture at the base of the nipple to hold the inverted nipple in a good position. The procedure is done under local anaesthetic and is relatively scarless.

Nipples that are too broad and too long can also be addressed surgically – the combination best treated with a so-called modified top hat procedure, which is very successful and gives a very natural appearance to the reduced nipple. Smaller procedures can be done, depending on the exact nature of the problem. All done under local anaesthetic as an outpatient.

Nipple reconstruction is usually done following breast reconstruction after mastectomy, and a variety of techniques are routinely employed. The nipple is usually created using local tissue flaps or composite grafts and the areola is most often achieved with a tattoo, although skin grafts may be used in addition.