Large and excessively projecting nipples can be a source of self-consciousness both publicly and privately. Many patients that I evaluate for a nipple reduction procedure state that their nipples have always been large, while some experience significant nipple enlargement during pregnancy and lactation.
Whatever the cause, nipple reduction is easily accomplished both as a part of another planned breast procedure such as augmentation or reduction, and as a stand-alone procedure in the office under local anesthesia. If an appropriate technique is used, nipple reduction is very safe with little risk of postoperative problems, it usually preserves nipple sensitivity, and it produces scars that are essentially invisible.
My preferred technique for nipple reduction procedures is what is commonly referred to as a ‘top hat’ flap. After injection of local anesthetic, and patiently waiting 10 to 15 minutes for epinephrine (vasoconstrictive) effect, an incision is made around the base of the nipple at the level of desired projection. The incision is not a complete circle; rather it is left incomplete from the 11 to 1 o’clock positions where a circular skin flap is created that will serve as the top of the nipple postoperatively.
The excess nipple tissue is then removed, and the circular flap is turned down to become the top of the now less-projecting nipple. The incisions are closed with tiny sutures that are removed one week postop.
Patients have little discomfort from this procedure and can resume full exercise activity after two weeks of limiting their activity to casual walking. The many patients for whom we have performed this procedure report little to no discomfort.
The goal is to produce an aesthetically pleasing nipple that still projects outward from the areola for a distance of perhaps 5 mm, and that appears to be in perfect proportion with the rest of the breast mound.
If you are troubled by nipple size and considering nipple reduction surgery, make sure that your surgeon can discuss with you clearly the technique they use for nipple reduction and show you several ‘before and after’ images of nipple reductions that they have personally performed.