Surgery for Absent, Enlarged or Asymmetric Areola or Nipples.

The areola is the pigmented area surrounding the nipple on the breast, and the nipple is the raised central portion of the areolar.

In some cases, the areola may be significantly asymmetric, enlarged, poorly positioned, or in post breast cancer reconstruction, absent. The nipple can also be enlarged, absent or inverted.  Some of these situations may be congenital, caused through age, pregnancy, breastfeeding, large weight gains or weight loss, hormonal changes, or breast cancer.  In some significant cases, patients may seek to have corrective surgery.

An excessively large areolar can be surgically corrected by excising the current areolar and using a surgical ‘cookie cutter’ to shape the areola to a more natural and even size.  The suture line is around the edge of the areolar and the scar usually blends in well with this edge over time.

If the position of the areolar requires adjustment this can be similarly cut away from the breast and the breast tissue is surgically adjusted to assist in repositioning the areolar to a more natural position.  In some cases, this may be in conjunction with a breast lift.  For further information on breast lift please click through to Breast Lift.

If the areolar and nipple are absent either congenitally or due to cancer surgery, surgery can be performed to create a raised ‘nipple like’ portion in the position of where the nipple is needed.

Micropigmentation of a Nipple

The use of micro pigmentation or ‘tattooing’ can then be used to assist in creating a pigmented areolar and darker pigmented nipple appearance on the breast.  It is important to have an experienced technician do this type of ‘tattooing’ in order to avoid a tattoo that has a ‘target’ appearance.

Nipples may also appear elongated, darkened, thickened, inverted or absent.  Enlarged nipples may be very evident through clothing for some women and men.  Surgery can be performed to adjust the size of an enlarged nipple or incases where a nipple is absent can be surgically created to look like a nipple.

Micropigmentation or Tattooing

The use of micropigmentation or ‘tattooing’ can then be used to assist in creating a pigmented areolar and darker pigmented nipple appearance on the breast. It is important to have an experienced technician perform this type of ‘tattooing’ in order to avoid a tattoo that has a ‘target’ appearance.

Nipples may appear elongated, darkened, thickened, inverted or absent. Enlarged nipples may be very evident through clothing  for some women and men. Surgery can be performed to adjust the size of an enlarged nipple, or in cases where a nipple is absent can be surgically created to look like a nipple.

The micropigmentation does not require sedation nor general anaesthetic.

What are Inverted Nipples?

Inverted nipple, or retraction of the nipple, are nipples that point inwards rather than out.  Inverted nipples can also cause concern and difficulties with breastfeeding.  Nipples are also one of the erogenous zones and if the nipple is inverted this may also affect sexual stimulation for some women and men.  The exact size, asymmetry and shape of an inverted nipple may be difficult to predict prior to everting the nipple. Further surgery may be required to make adjustments once the nipple has been everted.

An inverted nipple can be surgically everted, or can be trained to be everted by the surgical insertion of a nipple bar and support structure.  This later technique requires less surgical intervention and some patients also like the idea of nipple jewellery to train the nipple to be everted.

These surgical procedures are usually performed either under sedation or general anaesthetic and usually as a Day Theatre Case.


Risks and Complications

Surgery is not an exact science. Incisions and scars are part of any surgery and the location and extent of the incisions will be discussed with you. Every effort is made by the surgeon to minimise scarring. Scars will fade over time, but they are permanent. They can also become hypertrophic or keloid. Scars vary from person to person and are related to each individual’s skin type, genetics and the ability of their skin to heal.

Every surgical procedure involves certain risks and complications (as per the ASPS brochure) including, but not limited to:

Asymmetry is evident physically in every person.  No two sides of the body are ever exactly symmetrical in shape, position or size and the surgeon will make every effort to achieve as close to symmetry as possible but some asymmetry is normal.

Delayed Healing, Infection and Suture Reactions can all be possible healing issues and may require antibiotics or in some cases surgical exploration.

Bleeding, Haematoma or Seroma Collections may resolve themselves but, in some cases may require further surgery.

Loss of Sensation and Numbness may also be experienced. In most cases this will improve over time on its own. In some cases this can be permanent.

Bruising and Swelling may also be a short term effect from surgery and will usually settle in one to two weeks.

Allergies to dressings, medical lotions, sutures or other materials can occur with some patients. You will be advised to cease the use of the dressing, lotion or material that is causing the reaction. In some cases anti-inflammatory medication may be prescribed.

Breathing Difficulties may be due to a general anaesthetic or breathing tube during the operation which has caused some swelling, noisy breathing or discomfort.

Blood Clots can also occur in some surgeries and may require urgent treatment and hospitalisation.

Pain thresholds vary from patient to patient. This may lead to different pain management and/or different recovery times to resume normal activities.

Achieving excellent results with minimal risk is a joint effort. It is important to disclosed to the surgeon and clinic and understand the following:

Full disclosure of your medical history including: allergies, personal, physical and mental history, previous surgeries, current medications and co-morbidities (including but not limited to, smoking, vaping, diabetes, prescription and illegal drug addictions, blood or heart disease, obesity or anorexia).

Co-morbidities may impact on outcome and healing post surgery.

Smoking, vaping, or taking recreational drugs must be ceased in the 6 weeks prior to some operations and during the healing phase. Failure to do so may increase the risk of complications, decrease your healing ability and affect your surgical outcome.

You should not take aspirin based prescription drugs 14 days prior to surgery and during the healing phase of the operation unless advised otherwise by the surgeon.

As per the Australian Health Practitioner Regulation Agency (AHPRA), all non-rebatable (cosmetic) procedures require a validated screening of Body Dysmorphia to be undertaken.

If Dr Layt is concerned about your mental state or physical state prior to the procedure, he may request evaluation by a psychologist, psychiatrist, general practitioner or other specialist. This referral is to assess your suitability, increased risks during surgery or any underlying physical or psychological problems which may affect your recovery or mental health.

In some cases this may require surgery to be postponed or cancelled by the doctor in his primary role to consider your care and personal well-being.

Every patient is an individual and therefore final surgical results will vary from patient to patient.  Any surgical or invasive procedure carries risks.  Before proceeding, you should seek a second opinion from an appropriately qualified practitioner.