Q: I am interested in areola reduction surgery. I am fairly sure that I may have to lose more weight before I undergo any procedures. I was just wanting to know specifics about what I would need to do before I move forward.
A: There is usually a strong relationship between the size of the areola (diameter) and the size of one’s breasts. Although this isn’t 100% true, the larger the breast the larger the areola. Areolar reduction is a common part of almost every breast reduction and many types of breast lifts. But it can also be done as an isolated procedure if one is otherwise happy with the size and shape of their breast and just feel that their areolas are just too big.
Areolar reduction is done by a circumferential reduction, often called the donut procedure. A ring of the enlarged areola is removed and the surrounding skin sewn down around the smaller areola. This does result in a scar at the edge of the areola. How well that scar becomes in appearance in affected by how much the areola is downsized and how tight the surrounding skin of the breast mound is. For the best result in areolar reduction, the size and shape of the breast should be stable. Therefore, if you intend to lose more weight, it would be advised that you wait until you have achieved your maximal weight loss. By then the breast size will be stable and the resultant looseness of the breast skin will be an asset towards final areolar scar appearance.
Dr. Barry Eppley
Q: My boyfriend is concerned about the size of his areolas. Do you offer areola reduction surgery? He is very interested because he feels his nipples stick out too far and his areolas are too wide. They stick out when he is in t-shirts and some clothes.
A: The nipple and areola, known in plastic surgery as the nipple-areolar complex, is a two-tiered structure. Surrounding a central protruding and darker pigmented nipple, the areola is flat and much larger in diameter. The size of this complex can be quite variable with significant amounts of nipple protrusion and very wide areolas. But the extent of these variations is largely in women since this is a functioning gland that changes as a result of pregnancy. Men rarely show such variations in size as it serves no functional purpose.
Todays’ fashion and styles, however, have placed a little more focus on the nipple-areolar complex. Men do not like when their nipple protrudes through clothing and, rarely, a few men feel that their areola is too wide. Most wider areolar concerns are in patients with gynecomastia where the breast is also larger. But wide areolas can occur when gynecomastia is not present. In women, the typical areolar diameter measurement is around 38 to 45 mms. In men, those numbers are usually half those amounts.
Both nipple and areolar reductions are simple procedures. The nipple protrusion can be flattened by a simple wedge excision without any visible scarring. The areolar diameter can be narrowed by a circumareolar excision. This does leave a fine line scar at the junction of the areolar and skin. Both can be done under local anesthesia in an office setting.
Dr. Barry Eppley