We, the people of the United States of America, have a nipple fixation we can't seem to shake. We paint 'em on our nails, petition for them on social media, buy little stick-on faux nips that come in "cold" and "freezing" options, match our lipstick to our areolas... it seems we'll never tire of finding ways to make Europeans shake their heads at us.
But let them laugh as they lounge nude on the beach. We're finally getting more comfortable baring our bodies and taking charge of them — and that's a good thing. For some, that means accepting their stretch marks, cellulite, and breasts exactly as they are; for others, it means making the choice to alter them. And according to a survey conducted by The Plastic Surgery Group and the doctors we spoke to, more and more women are opting for the latter when it comes to their nipple and areolas.
Who is getting these procedures?
According to both doctors, the majority of patients coming in for nipple/areola reconstruction are postpartum women of all ethnicities in their late 20s to mid 40s. "The skin on your breasts has been stretched during pregnancy, and even after losing the pregnancy weight, the skin may be loose, making the breast appear saggy and the nipple larger than before," says Dr. Ip, adding that it's also common for a woman’s nipples to be darker after pregnancy and breastfeeding.
Dr. Rowe estimates that 50% of postpartum women who come to his practice for a breast lift or augmentation also request alteration of the nipple or areola, compared to 15 to 20% of women who haven't had children.
Are nipple area surgeries only done during breast augmentations?
While most patients choose to alter the nipple while getting a breast lift or implants, it can certainly be done as a standalone procedure. Dr. Rowe says, "I get two types of patients: Women who find they're happy with the size of their breasts, the position, the cleavage, but they're just not happy with the nipple or areola. Or patients who say, 'As long as I'm getting a breast augmentation or as long as I'm getting a lift, could we do something about this?'" He estimates he does 10 nipple/areola procedures, sans breast augmentation, a month.
Dr. Ip says that while isolated nipple procedures are rare in his practice, he has "noticed that more and more patients are increasingly concerned about the appearance of their nipples. Patients are asking for smaller, symmetrical areolas with more prominent nipples."
How do you do a nipple reduction? Enlargement?
According to Dr. Rowe, an average nipple is anything less than two centimeters long from the base outward, and Dr. Ip says that most of his patients undergo reductions because they're bothered by the visibility through clothes and the chafing that occurs, mostly during exercise. The procedure is surgical, but both doctors emphasize how quick and easy it is — it's done under local anesthesia in less than an hour.
After measuring how much tissue will be needed to achieve the ideal length, a small incision is made and the excess tissue is removed, either from the top or around the circumference. Then, Dr. Ip says, "I purse string-stitch the top, which allows the nipple to kind of sink in, giving a natural appearance."
Enlargement is an even easier, minimally invasive procedure that simply involves injecting very small amounts of the patient's own fat or hyaluronic acid filler into the nipple for added volume.
Is there a risk for loss of sensation in the nipple?
"If you are only fixing areolas or nipples, there should be no loss in sensation," says Dr. Ip. "The change in sensitivity occurs when you manipulate the breast tissue with a breast implant. The breast sensory supply comes from the sides of the breast, so when doing an incision around the areola, it should remain the same."
How does this affect breastfeeding?
"If you want to enlarge a nipple or reduce, there's a really minimal chance of loss of sensitivity or ability to breastfeed. As far as any procedure we do on the areola, that doesn’t have any impact whatsoever on sensitivity or ability to breastfeed," says Dr. Rowe. But, he says, in the case of inverted nipples, things get a little trickier.
What's the deal with inverted nipples?
First, you have to make sure the nipple didn't suddenly go from an outie to an innie, which can signal something more serious and should be assessed by your doctor. If someone has always had inverted nipples or has had them since puberty, chances are things are fine, says Dr. Rowe, who explains that they're usually caused when milk ducts constrict and pull the nipple in.
"A lot of people go in there and cut those ducts and it releases the nipple, but what I've found to be an issue with that is, one, you have a scar on your nipple, and two, you may lose the ability to breastfeed," he says, though he acknowledges that many people with inverted nipples aren’t able to breastfeed to begin with. His approach? "I numb up the nipple, then I pull it out and put a piercing at the base, which keeps the nipple out. You leave that piercing in for about three months and after that, those ducts have been stretched and you can remove the piercing without the nipple inverting, and usually, with sensitivity intact."
What are your options when it comes to areola augmentation?
Both doctors say that areola reduction is the most popular request in their practices, especially among new moms who find that the area has enlarged after pregnancy. "The average size areola for a Caucasian woman is about four centimeters across, which is just under two inches, so that’s what a lot of women go for," says Dr. Rowe.
Often, a breast lift is enough to reduce the size, says Dr. Ip, since it removes excess skin from around the areola, but in other cases, a circumferential incision is made around the border of the areola, some tissue is removed, and dissolvable stitches are used to seal it.
And areola enlargement, though rarer, isn't unheard of. Dr. Rowe sees women, many of whom are of Northern European descent, whose areolas are so faint, they just look like regular breast skin. In those cases, he can make an areola in the same way specialists would do for breast reconstruction patients post-mastectomy. "For that rugated, rough texture of a regular areola, you can put a skin graft on in three dimensions. It heals with some bumps and looks like an areola," he says.
But when an areola is easily visible and the patient just wants it to be larger, he stays away from grafts and tattooing, which he finds look too obvious. "Instead, I put tension on the areola with deep sutures and it slowly stretches out the areola. It's a painless procedure," Dr. Rowe says.
What's the recovery like?
Quicker than you'd likely expect. "You're back to work and your normal routine in about 24 hours," says Dr. Rowe. The stitches used are dissolvable, too, so you don't need to have them removed at your follow-up appointment.
One 43-year-old woman, Lori, tell us she "loved [her] small breasts, but hated how far [her] nipples stuck out from the side ever since she was a teenager," so she decided to get an isolated nipple reduction nearly a decade ago. "My nipples were really sore and sensitive for about a week, but I only took one painkiller and went out to dinner the same day I got the surgery. It was surprisingly not a big deal at all."
Marta, a 36-year-old mother who went to Dr. Ip for a breast augmentation and areola reduction eight months ago, also says her recovery was unexpectedly simple. "I had my surgery on a Wednesday morning and mostly just slept for the rest of the day and took a painkiller. I took the meds on Thursday and Friday, too, but on Saturday, I woke up feeling completely like myself. I could move my arms up and down and I didn’t even need a Tylenol."
Is there scarring?
Within a few months, the scars will fade and you'll likely be left with a very faint, thin line where the incision was made. Lori's nipples healed perfectly and she says, "they look exactly like the ones I was born with, just smaller," while Marta tells us, "I just have a really fine white line around the areola, but if you saw me topless, you would honestly not be able to tell I had anything at all done to my breasts.
How much does it cost?
Isolated nipple and areola procedures run from $1,500 to $2,500 and breast augmentations range from $7,000 to $17,000.
August is Breastfeeding Awareness month. For more stories on nursing, pumping, or choosing not to do either, visit our Mothership page.
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