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Nipple Surgery: The Last Frontier of Cosmetic Surgery?  (Cosmetic Surgery)
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Nipple Surgery: The Last Frontier of Cosmetic Surgery?

Mariusz J.A. Sapijaszko, MD FRCPC (Dermatology)

Nipple aesthetics are a significant concern to both men and women. Nipple shape, size, symmetry as well as textural characteristics are all important when considering nipple revision or correction. The most common concerns include, among others, nipple size asymmetry, enlarged nipples in men and inverted nipples in women. Traditionally, nipple surgery has been a domain of plastic surgeons, but recently dermatologists have been asked to help patients with this rather common concern. Surgically inclined dermatologists are uniquely suited to perform these procedures and they are familiar not only with the regional anatomy but are also experts in skin function.

Although there is no single standard for a proper nipple, it is generally agreed that a normal nipple should be flat or slightly erect. These aesthetics vary from men to women and from culture to culture. Inverted nipples, and nipples that are located lower than the surrounding areola, are considered unattractive for women. Comparatively, enlarged nipples are considered undesirable traits among men.

The most common concern in women regarding their nipple characteristics is the inverted nipple. This can have both functional and aesthetic implications. In most severe cases, recurrent infections, inflammation and difficulty or impossibility of breastfeeding is noted. It is felt that the most common cause of inverted nipple is the lack of bulk in the connective tissue that normally prevents the nipple from being retracted by muscle and connective tissue fibres that are associated with glandular milk ducts of the breast tissue. This can also be associated with shortened breast ducts.

There are different severities of inverted nipple with the mildest form present when the inverted nipple can be easily pulled out and maintain its projection quite well without retraction, and the most severe case where it is very difficult to manually pull it out. In the most severe cases, there is a great deal of fibrosis (thick and strong attachments) that holds the inverted nipple in place. The detailed understanding of the severity of nipple retraction/inversion is critical in planning any corrective measure. In addition to optimizing the visual aspect of the surgical correction, it is important to preserve the normal sensation to the nipple and preserve possibility of future breastfeeding.

The main methods of inverted nipple correction are classified into three groups: the first method proposes to create tightness at the neck of the inverted nipple, the second is designed to add bulk beneath the nipple after cutting its ductal system, and the third method uses duct-saving, partial areolar and nipple muscle excision and reconstruction using buried sutures. Recent advances focus on minimally invasive procedures where the ducts and the nerves are maximally preserved allowing for normal function and breastfeeding following the correction.

For men, different nipple issues are of more concern. Prominently protruding nipples in men are considered, by many to be undesirable and are a frequent cause for concern. The corrective surgery for decreasing the size of nipples is less complex than the correction of inverted nipples and generally involves subtle debulking and flap closure. This procedure generally results in excellent aesthetic results.

Nipple inversion in women and nipple protrusion in men are significant aesthetic concerns. Although most of the corrective surgeries are performed by plastic surgeons, more and more dermatologic surgeons are asked to assist in this common problem. Several techniques are available to address individual anatomic variations and it is important for patients to know that help is available and they are not the only one having this challenging concern.


cosmetic surgery,   cosmetic treatments,