David B. Reath, MD
Knoxville, TN (865) 450-9253

Breast Augmentation & Nipples: Questions You Didn’t Know You Had

Dr. David Reath, a board certified plastic surgeon in Knoxville, discusses breast augmentation and nipples.When women are having surgery to improve the appearance of their breasts, one of the concerns is how the shape of the nipple and areola will change. Specifically, does having breast implants affect the shape and size of the areola? And, because inquiring minds want to know, I will discuss this. (I was going to say “wax eloquently” but I thought that was a bit over the top.)

Nipple Nomenclature
Before we dive into the questions, let’s start with defining the lingo. When most women talk to me about their “nipples” what they are really referring to is the areolas (or areolae for the Latin scholars). The nipple is the center projection column of the nipple areolar complex, otherwise known as the NAC. This is where milk comes when breast feeding, and also has the erectile properties when the breast is cold or stimulated. Some women have problems with inverted nipples. Others feel their nipples project too much (we have an easy solution to this.)

The areola is the darkly pigmented skin of the center of the breast. Sometimes areola have some small bumps called Montgomery glands. Most women contemplating breast surgery have some concerns regarding the size and shape of the areola, so this is something that I work with much more than the nipple itself.

First question: Do breast implants change the size of the areola?
Well, to answer this question, I looked back through the photos of breast augmentation that I have on our website (all 205 of them). Basically, the answer is “no,” or “not really.” The nipple areolar complex (NAC) will either be unchanged or may look a bit fuller. But it does not get larger from a breast augmentation alone.

Second question: Can the shape of the areola be changed?
Yes. To do this, a surgeon must perform some type of breast lift (mastopexy) or breast reduction. Some women have large and over-projecting areolas with or without some degree of breast sagging. Frequently a peri-areolar mastopexy can correct this. During the procedure, some of the areolar skin is removed and a purse-string suture is used to cinch up the skin around the areola to achieve a narrower diameter to the NAC. In other types of mastopexies and breast reductions, the areola diameter is narrowed as a result of the design of the operation and how the excess skin is removed.

Third question: What can be done if the nipples themselves are retracted?
This can be treated as well. The reason for the retraction is that there are ducts attached to the nipple from the underlying breast tissue which invert the nipple. These ducts can be divided to allow a normal or non-retracted appearance to the nipple. However, this can affect nipple sensitivity or breast feeding. In some women I can do this at the same time of their breast augmentation, but it can also be a separate procedure.

Anything else?
Well, the only other thing that I have done on occasion is to recess the nipple in someone with overly projecting nipples. This is not a common operation, but one that can be done. But for women who are self-conscious about their nipples showing through their clothing, Dimr’s can be used to cover the nipples and conceal them, so to speak.

So as for affecting the shape and size of the nipples and the areolas, that’s about the long and short of it.
All the best,

Dr. David B. Reath




David B. Reath, MD

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