Q: Dr. Eppley, I am considering getting nipple reduction surgery if this is possible. I am a 19 year-old male college student who has a very athletic body type. I suspect I have always had nipples which stuck out and they didn’t used to bother me. But now they do and it has been giving me self-esteem issues. What type of surgery do I need to correct this problem, how is it done, and how long is the recovery?
A: When I get requests for ‘nipple reduction’ surgery, it is important for me to discern exactly what the problem is. Nipples can stick out from two causes and the difference is in understanding the anatomy of the nipple-areolar complex.. The first is true nipple protrusion or hypertrophy. This is where the small central raised nipple sticks out too far, either all the time or when it becomes temporarily erect. This creates a small almost sharp point that can be seen through shirts or makes for a non-smooth chest profile. Nipple reduction is essentially a wedge amputation, is done in the office under local anesthesia, and will produce a permanently flat nipple. There is no recovery at all. The other cause of the entire nipple-areolar complex sticking, also mistakenly called a protruding nipple, is gynecomastia. When the size of the gynecomastia is small, it can push out the entire nipple-areolar complex. This makes a ‘nipple mound’. This areolar gynecomastia reduction is removed through a lower areolar incision and is done in the operating room under general anesthesia as an outpatient procedure. The enlarged and firm mass of breast tissue is removed to bring the profile of the nipple-areolar complex back to a smooth chest contour. There is about 7 to 10 days of recovery in which the patient wears a circumferential chest wrap to reduce the chance of any fluid collection in the space where the breast tissue was removed.
Dr. Barry Eppley
Q: Dr. Eppley, I am curious about nipple reduction. I am an athlete with only about 10-12% body fat but I have nipples that stick out. I have always been self-conscious about the kind of shirts I wear or even taking my shirt off. I would like more information on what is best for my situation.
A: When one is concerned about nipples that stick out, it is very important to differentiate between true nipple protrusion and areolar gynecomastia. Both can cause protrusion from the nipple area but they appear quite differently on close inspection anad are treated with different techniques.
The commonly called nipple is really better understood as the nipple-areolar complex. There is a central protruding nipple surrounded by a flat pigmented areola. In men, the nipples are smaller because the size (diameter) of the areola is very small. In nipple protrusion or hypertrophy, the small central nipple sticks out while the surrounding areola is flat. This makes for a small point that sticks out in shirts. It is treated by a simple nipple reduction done under local anesthesia in the office. Most of the nipple is removed so it lays flat and will never protrude again. In areolar gynecomastia, there is a mass of breast tissue that pushes out the whole nipple-areolar complex. This is better called a ‘puffy nipple’. It is treated by removing this mass of breast tissue through a small areolar incision. This is done as an outpatient procedure under IV sedation or general anesthesia.
Dr. Barry Eppley