What About the Nipples?

What happens to the nipples during breast surgery?It might seem like a little bit of a mystery. What exactly happens to the nipples during breast augmentation, breast lift, or breast reduction? And what if I don’t like my nipples? Can something be done about that?

Those are great questions, because the focus for many people interested in breast surgery is on size, or maybe sagging. Since the nipples do play an important role in the look of the breast, it’s important to consider how any surgery will affect them. But before we talk about how surgery can impact them, let’s dig into a little anatomy.

When someone says “nipple” what exactly are they referring to? Not everyone uses the same terminology, but there is a technical definition.  

The central, circular area on the breast that is pigmented is called the areola. The color can vary from light pink to dark brown – all normal. The size can vary widely, too, and that’s normal. On some women, small bumps on the areola are obvious. These are called Montgomery glands. They are normal.

In the very center of the areola, the nipple projects outward. The milk ducts exit through the nipple. Like the areola, there are lots of variations that are normal for the nipple. They can be large or small, project a little or a lot, or even be inverted.  

Together, the areolae or areolas (either way you want to pluralize the word is fine) make up the nipple-areolar complex, or NAC. Sometimes people refer to the nipple, but what they are really talking about is the NAC.

What If I Don’t Like My Nipples?

Even though there is a wide range of normal, not everyone feels comfortable with the way their nipples look. They wonder if there is something that can be done to change that.  

The answer to their question is yes. There are procedures that can change the appearance of the nipple, areola, or both. Often this is done in concert with a breast lift or breast reduction surgery, where the NAC can be repositioned or resized – often correcting a low or sagging appearance. Asymmetry, where the areola is larger on one side than the other, can also be addressed in these surgeries. Take a look at Dr. Slack’s before and after galleries for breast lift, breast lift with augmentation, and breast reduction to see some ways the nipple can be changed in these surgeries.

Less frequently, a procedure may be undertaken that just addresses the nipple or areola. For example, inverted nipples are caused by the milk ducts pulling the nipple inward. The connection between the ducts and the nipple can be removed by a plastic surgeon so that the nipple protrudes outward in a more typical way, but it may affect the ability to breastfeed. Size, shape, or symmetry issues with the areolas may also be addressed separately from other surgeries.

What If My Nipples Are Fantastic Just Like They Are?

Other people may see no reason to mess with a good thing, so they are concerned the appearance of their nipples might change as a result of breast surgery. The good news for these folks is that breast augmentation doesn’t have to have a dramatic affect on the appearance of the NAC, although adding the extra volume of an implant can spread out a loose areola making it look larger. If you take a look at the Dr. Slack’s before and after gallery for breast augmentation, you can get a feel for how the procedure affects the nipples.

Even with breast lift or reduction, it’s up to you how much the size of the areola will be reduced, though the location will necessarily be different in these procdures.

How Do I Learn More About How Breast Surgery Affects the Nipples?

It’s best to have this conversation with your plastic surgeon to get a clear picture of how a procedure will or will not affect the appearance of your nipples and areolas, and if it will have a negative effect on sensation or your ability to breastfeed. Each person is different, and a consultation with an expert will give the best picture of what to expect.

In addition to his residency in plastic surgery, Dr. Slack completed a fellowship in Cosmetic and Reconstructive Surgery of the Breast at Georgetown University Hospital in Washington, D.C. He is an expert in understanding exactly how a surgery will affect the nipple, areola, and breast overall. If you have questions about any type of breast surgery, contact our Allen office to schedule a consultation with Dr. Slack.