Nipple and Areola Reduction
Nipple and/or areola reduction is a brief outpatient surgery that effectively reduces the size of the nipple and areola. This procedure can be done alone, and it also can be done in conjunction with any other Los Angeles Mommy Makeover breast surgeries. For women with enlarged areolas or nipples, this surgery can provide great relief from cosmetic issues that cause embarrassment or lack of confidence.
Nipples and areolas may be enlarged from birth. They may also be enlarged due to overly large breasts that sag, stretching the areola with their weight. In some cases, breastfeeding stretches nipples beyond their regular size. Those patients are typically the ones who look to Dr. Rady Rahban, Bevery Hills Mommy Makeover surgeon and specialist, to provide some of the most beautiful results from the best Mommy Makeover Los Angeles moms rave about. Whatever the cause, nipple and areola reduction is an effective solution, allowing women to find comfort with their breasts.
Nipple and areola reduction procedure
This procedure can be done in-office under local anesthetic or as an outpatient procedure, depending on the patient’s comfort level.
Each nipple and areola is different, prompting the need for multiple surgical approaches. Most commonly, Dr. Rahban addresses enlarged nipples by using a telescoping technique, in which he removes redundant tissue at the base of the nipple, allowing him to set back the nipple into the areola. With this approach, the nipple retains sensation and breast milk production. If a nipple is too large, another technique called the transecting technique whereby the nipple is reduced from the top down. With this technique, sensation and breastfeeding may be altered.
In reducing the areola, Dr. Rahban makes an incision around the areola in the size that he would like. He then makes a second incision around the residual pigment that is larger than the desired areola. He then removes the intervening pigment and subsequently closes the outer incision using a pursestring technique. This allows the overall size to be significantly smaller. If the reduction is significant, it is crucial that a permanent suture be used to perform the pursestring closure. Otherwise the areola will stretch with time and can become much larger than when it began.
Occasionally, the areola is reduced in conjunction with other procedures such as a breast lift or reduction, as large areolas are commonly part of the problem with large or sagging breasts. This allows Dr. Rahban to reduce the areola while concurrently lifting and shaping the entire breast.
Note: while each surgeon approaches the recovery process differently, the recovery listed below is according to Dr. Rahban’s routine. Other surgeons may have a different approach to the recovery process.
Nipple and areola reduction requires very little downtime once the procedure is over. In general, patients can return to their normal routine the very next day. We ask that patients refrain from vigorous exercise for four to six weeks after surgery. While this is a relatively minor procedure, all wounds require a minimum of four to six weeks to heal without any tension, otherwise the scars will become unsightly and stretch.
At the time of your surgery, your wound will be sterile, and it will be covered with a sterile dressing. Dr. Rahban will ask you to keep that dressing on for seven days. While some patients feel as though their wounds are getting dirty, it is exactly the opposite. Non-sterile materials such as fingers and water introduce bacteria that cause infections. When you open your wound to clean it, you may also contaminate it accidentally.
After the first week of recovery, Dr. Rahban will give you further instructions as far as maximizing your cosmetic outcome and minimizing your scars.
Risks of nipple and areola reduction
Nipple and areola reduction risks include but are not limited to:
Nipple reduction scars tend to heal incredibly well, as the nipple tissue is very unique. Areola scars, however, can heal with varying degrees of visibility. It is critical that the closure be done under no tension. Areola tissue can expand over time if the technique is not done correctly, making a larger areola than one began with.
No two nipples or areolas are ever identical before surgery, nor will they be after surgery. The goal, however, is for them to be very close in size and shape. Hence, if there is any asymmetry to begin with, Dr. Rahban will make every effort to correct it.
This is a very rare complication. Despite this, we take action to minimize the risk as much as possible. This primarily includes having the patient stop all medications that promote bleeding at least two weeks in advance, such as anti-inflammatories, aspirin and supplements.
Also quite rare, infection is thoroughly combatted before, during and after surgery. The night before surgery, we have patients wash themselves with an antiseptic soap. We give patients antibiotics directly prior to surgery, as well as after surgery. Additionally, Dr. Rahban has very strict post-operative instructions regarding wound management that he believes reduce the risk of infection.
Loss of sensation to the nipple
If the telescoping technique is used, there should be no change to sensation. If, however, the transection technique is necessary, then one can expect some change in sensation
Reduced breast milk production
Similar to nipple sensation, if the transection technique is used to reduce one’s nipples there will be a reducton in breast milk production.
Cost of nipple and areola reduction
There is no standard cost for nipple and areola reduction as there are many unique variables. Below is a list of the elements that will determine the cost of your procedure so you understand what exactly you are paying for.
- The skillset of your surgeon. Is he or she a plastic surgeon or a cosmetic surgeon? Is he or she board certified? A board certified plastic surgeon will often be more expensive.
- How long it takes to perform the procedure. Generally the faster your surgeon, the less facility and anesthesia fees and the greater the surgeon’s profit. Therefore, surgeons have an incentive to work more quickly. When it comes to surgery, faster is not better. Be sure to ask your surgeon how long the procedure will take and be wary if it seems too quick. The average time for nipple and areola reduction is: 1-2hr
- The anesthesia provider. There are many types of anesthesia providers. An anesthesiologist who is a medical doctor will be more expensive than a nurse anesthetist. Do your research and find out who provides anesthesia for your plastic surgeon. Dr Rahban is partial to using an anesthesiologist as opposed to a nurse anesthetist.
- The facility in which your operation is performed. Unfortunately, surgery centers and hospitals are not all created equal. The more sophisticated the facility, the more expensive its hourly fee. Facilities that are Medicare-certified tend to be more costly as well.
Questions to ask your surgeon
Below are specific questions to ask your surgeon during your consultation. Each of these will allow you to understand his or her approach and thus make an informed decision. To print these questions so you can ask your surgeon, see link below to download a copy take with you to your consultation.
What technique will you use to reduce my nipples?
Most commonly, Dr. Rahban addresses enlarged nipples by using a telescoping technique, in which he removes redundant tissue at the base of the nipple, allowing him to set back the nipple into the areola. With this approach, the nipple retains sensation and breast milk production. If a nipple is too large, another technique called the transecting technique whereby the nipple is reduced from the top down. With this technique, sensation and breastfeeding may be altered.
What’s your technique for reducing the areola? Will you be using a permanent suture around my areola?
In reducing the areola, Dr. Rahban makes an incision around the areola in the size that he would like. He then makes a second incision around the residual pigment that is larger than the desired areola. He then removes the intervening pigment and subsequently close the outer incision using a pursestring technique. This allows the overall size to be significantly smaller. If the reduction is significant, it is crucial that a permanent suture be used to perform the pursestring closure. Otherwise the areola will stretch with time and can become much larger than when it began.