Your Questions
Your Questions
Q: Dr. Eppley, I was just wondering how much the nipple reduction procedure costs. I have protruding nipples that seem “puffy”. I would love to have them lay flat so that I can quit wearing undershirts and join in on summer activities such as swimming. Please let me know.
A: Thank you for your inquiry. There is a difference between protruding nipples and a puffy areola. While sitting right next to each other, they can be very different and require different approaches to treating. One is a simple office procedure to reduce the length of the nipple. (protruding/raised/long nipple) When men use the term ‘puffy nipple’, they are usually referring to the whole nipple-areolar complex that sticks out which is really a very mild form of gynecomastia. That is treated quite differently by excision of the excessive gland tissue under the nipple through a small procedure done in the operating room. A protruding nipple reduction has no recovery at all while the areolar gynecomastia problem requires several weeks of avoiding strenuous activities such as exercise of swimming.
As you can see, I need a clear idea as to exactly what you are referring to. Sending a picture would be very helpful in making that important distinction between the two conditions.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like a nipple reduction and have it lifted as the same time. What are my options for having this done? I have attached some pictures of my nipple concerns.
A: Thank you for sending your pictures. In my experience, there are two basic types of elongated nipple deformities. The first type has a narrow base and the nipple length is usually 3x to 5x longer than the base width which is why it hangs down like a willow tree branch. This is the easiest and most successful nipple reduction result as shortening the nipple length immediately lifts the nipple back to its base level. The second type of elongated nipple has a very wide base and the nipple length is only 2x or so of its base width. It is heavy and the entire nipple base sags due to its weight. This is a bit more challenging to get an optimal result as shortening the nipple length with such a side base can lead to a potential ‘pinched’ nipple look. Based on your pictures, you have a type 2 elongated nipples
In addition, there are two types of nipple reduction techniques. The first is a wedge reduction technique where the nipple is bivalved at the desired level and sewn back together. This places the fine suture line across the top of the nipple. This may reduce nipple sensation. This is the best technique for a type 1 elongated nipple. The second nipple reduction technique is a base circumferential (donut) reduction method where a ring of nipple tissue is removed from around the nipple where it joins the areola. A central core of nipple tissue is preserved and the remaining outer nipple is then pulled back and sewn to the areola. This places the suture line around the base of the nipple and preserves nipple sensation. This is often more appropriate for a type 2 elongated nipple though the amount if nipple reduction and lift is less.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering approximately what cost I could expect for a nipple reduction? Breast size is 32B and nipples are nearly an inch long and half inch wide. Because of their size, they are heavy and sag.The only thing I would be interested in would be a simple width/length reduction of the nipple and nothing with the breast or areola size. I would also like to retain as much feeling as possible. Thanks!
A: I will have my assistant forward that cost information to you. Most likely the cost will be around $1500. There are two different techniques for nipple reduction. The one that is the most effective at length reduction also runs the greatest risk of some loss of feeling. The nipple reduction technique that preserves the most sensation is the one that will produce a more limited amount of length reduction. No nipple reduction technique is very effective at reducing the diameter of the base of the nipple.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 27 year-old male. I have my nipples removed 8 months ago because it was too sensitive. I know the male nipple can be highly sensitive sexually and most of the men enjoy it but in my case I am unhappy with this sensation from childhood because it is intolerable and disgusting. And you know more than 30% male do not like that. I am among those men. So if someone tell that it is one kind of mental disorder, I do not believe it since I have taken mental and skin treatments since 2007 but there was no progress and I do not want to spend anymore money for medication. However, after the reduction of nipple there is little sensation on the center of the areola until now. When this place is pressed, it make me feel of the same sensation that I felt before. Finally, I have decided to remove the areola totally and want to make this place permanently numb. So what I want to achieve is the following:
1. Permanent numbness on areola by removing them.
2. Removing breast gland. (Actually, I have removed breast gland before but just need to check whether any gland tissue left. If it is then need to remove it.)
3. Removing whole areola. (It is not just the upper surface but also inner part. I mean after removing areola it will looks like a hole on skin.Probably, numbness surgery and whole areola removing may be at the same time.)
#2 and #3 is not mandatory but #1 is mandatory for me. #2 is optional.
*** It is notable that My problem is not gynecomastia. This surgery will be just for numbness on areola place to live rest of life with happiness. I think it can be done by local anesthesia.
A: The most likely reason you only lost partial nipple sensation is that only the tops of the nipples were removed. The nipple and its ducts extend deeper which is where it receives its nerve supply and sensation. While initially after surgery the nipples were completely numb, some feeling has returned because these deeper tissues remain. While the entire areola can be removed, it should not be necessary to do that to eliminate all sensation permanently. A lower areolar incision can be made and all tissues removed right up to the underside of the dermis of the areola. When this is done, the remaining areola is just a cosmetic feature on the outer side of the chest skin. As you have mentioned, removal of the areola will result in a purse-string type scar on the chest wall which may be indented. I am not sure that is a good trade-off but only you can make that decision. I would agree that either approach could be done under local anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have read about nipple reduction surgery and think that it is what I want to have. I am 45 years old but have long had nipples that stick out too far. There is barely any type of shirt that I can wear that hides them. My teenage son who is 15 years old has the identical problem (bad gene!) and I don’t want to see him suffer as I have over the years when there appears to a good solution. Would he qualify for this surgery? Also since we are from out of town can we have a consult and the surgery the same day? Thanks!
A: With parental consent, your son would qualify so there is no concern with that issue. Consults can be done by phone, Skype or e-mail so there is no reason to come for in for ani nitial evaluation when the problem is so visually obvious. I would just send me a picture or two of your and your son’s nipples for my assessment. Obviously they are too long and protruding but it would be nice to see them anyway in advance.
Usually nipple reductions are done under local anesthesia as a simple outpatient procedure. They should not be confused with more complex procedures like gynecomastia reductions.Whether a 15 year-old could handle that or not under local anesthesia I do not know although I suspect so. The toal cost of the procedure is $1500. You would just book the procedure(s) through our office after I have evaluated the pictures so it would be a one-time visit. Dissolveable sutures are used so there is no return follow-up needed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello, I am a 27 year-old athletic male who is bothered both my puffy nipples. Some days they don’t seem that bad. But other days they really stick out. I don’t know why they are so different on different days. I am not sure whether I need my nipple cut down or the tissue under the nipple removed. Whatever it takes to do it I don’t care as I just want it gone. What do you recommend and what is the surgery like and how quick will I recover?
A: Puffy nipples are different than pointy nipples as patients often describe these two male chest problems. A pointy nipple is when the centrally located nipple within the areola sticks out like a small sharp point. It is small protrusion and is managed by a simple nipple reduction which is an office procedure done under local anesthesia. There is no real recovery as small dissolveable sutures at placed and one goes about their activities as normal immediately afterward. A puffy nipple refers to the development of a small mass of breast tissue underneath the nipple-areolar complex that makes it stick out or be puffy. This is known as areolar gynecomastia and is a limited gynecomastic reduction. It is treated by an outpatient procedure in which the enlarged breast tissue is removed from under the nipple by a small lower areolar incision. Patients wear a chest wrap for a week or so and show refrain from exercise or strenuous exercise for a few weeks to avoid a fluid collection or excessive scar tissue formation which will wipe out the benefits of having the puffy breast tissue removed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in making my nipples less prominent. I think they stick out too far and it can be embarrassing sometimes with different types of clothes and in colder weather. How big of a deal is it to go through and what is the recovery?
A: Nipple reduction surgery is really a very simple procedure. While nipples are undoubtably very sensitive, they can easily be made numb with a little injection of local anesthetic. The actual size of the nipple is quite small so the procedure is appropriately a minor operation. When done by itself, it is an office procedure that takes less than one hour for both nipples.
There are two basic nipple reduction techniques. Which one is best for any patient is determined by how much nipple reduction is needed and how much nipple sensation one wants to preserve. Either way, small dissolveable sutures are used so there is no need for a follow-up suture removal appointment. A small band-aid is used for the dressing. One can shower the next day and not be concerned about getting the area wet. A little dab of antibiotic ointment and a daily band-aid change is all that is needed for one week after surgery. There are no physical restrictions and one can return to running and working out the very next day. I would not, however, immerse the breast in a hot tub or swimming pool for at least one week after the procedure is done.
Nipple reduction surgery creates an immediate change. Even with the little bit of swelling that occurs, the change is readily apparent. Complete settling of the nipple takes about three weeks until its final shape and amount of residual projection is seen.
Dr. Barry Eppley
Indianapolis Indiana
Q : I am bothered by the size of my nipples. They stick out too far. It is embarrassing in shirts. They are even noticeable in bras unless they are padded. I often wear nipple pads or ‘dimmers’ so they are not so obvious. I am interested in having them reduced but am afraid of losing all my feeling in them. Can you tell me how this procedure is done?
A: There is no standard size or length for what a nipple should be. But when its length becomes a socially embarrassing issue, then nipple reduction should be considered. Reducing the length of the nipple is a simple procedure that can be done under local anesthesia. It can be done alone or in combination with most forms of breast surgery, most commonly breast implant augmentation.
The nipple can be reduced two different ways depending upon its size, how much reduction one wants to achieve, and if as much feeling as possible wants to be maintained. A wedge excision of the nipple can be done which will reduce its length by at least half if not more. (depends on the size of the wedge) This will eliminate the possibility of breast feeding and some feeling will definitely be lost. (how much can not be predicted) The other option is a circular or donut reduction where a ring of nipple tissue is removed at its base. Breast feeding will still be possible and the least potential for feeling loss is the benefit of this approach.
Either method uses dissolveable sutures with only a band-aid for a dressing. One can shower the next day. There are no restrictions after nipple reduction surgery.
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
