I have patients come into the office all the time concerned about their nipples. Often it’s not the nipple at all that concerns them, so let’s go over some anatomy.
What people are often talking about is the NAC. The nipple areolar complex. This is the nipple/areola together as a unit. People also have questions about the “bumps around the nipple” that are irregularly spaced around the areola. These are montgomery tubercules. They can occasionally occur on the nipple itself. Their primary goal is to produce oil, and typically become larger in pregnancy or sometimes during a woman’s menstrual cycle. Now that we have the basic anatomy out of the way, let’s answer some of the most common questions I get about the NAC, both before and after a procedure.
Q: What are these bumps and can I have them removed?
Women typically mean the Montgomery tubercles when they say this. Sure, you can have them removed, but why would you? They have a job, are tiny, don’t cause problems, and are completely normal. I encourage these patients to save their money and buy something fun instead of a procedure to remove something normal that can leave a visible scar which is not typically more aesthetic than the gland itself. Now if you have one large abnormal one, let’s remove it if you find it bothersome.
Q: My nipple is too long, can you shorten it?
Yes we can! There are two techniques to shorten the nipple. One is to remove some skin at the base and telescope it in. The second is to amputate the tip which actually heals beautifully. The second option is more likely to preserve your ability to breastfeed.
Q: My nipple is too wide. Can you make the diameter smaller?
Why, yes we can! If your nipple is too wide, we can do a wedge resection to make the diameter smaller.
Q: My areola is too light or too dark, can you change this?
The simple answer is probably not. It is quite difficult to change the natural color of your areola and I do not recommend trying. Using skin lighteners or lasers can sometimes lighten the color, but darkening is difficult. I find the results unpredictable and expensive.
Sometimes after breast surgery, the areola color will darken for 6-12 months. This is most common in people of color and typically improves with no intervention. If your areola becomes very light from poor blood supply after surgery and no longer looks normal, you can go to a 3D tattoo expert. I recommend Holly at The Gilded Lily. She works with my breast cancer patients and is amazing.
Q: My areola is too wide, can you make it smaller?
Yes we can! An areolar reduction is also called a circumareolar mastopexy. Although these procedures can reduce the size of the areola, it’s important to know that they are notorious for stretching out over time. Sometimes they even become larger than they started. So now you have a scar and a large areola.
If your breast is a bit droopy or ptotic, converting the circumarolar mastopexy to a vertical (lollipop) mastopexy is more likely to keep the areola the desired size with the side effect of a more perky youthful breast. The markers that we use in the OR are 38, 42, and 45 mm in diameter if you are interested in seeing how your areola stacks up.
Q: I had breast surgery and my areola is indented at the bottom, can this be fixed?
The dreaded tethered inferior periarolar scar is a common complaint from patients. This incision is rarely used for primary breast surgery these days as it is associated with an increase in a variety of complications. Unfortunately, there are many women running around with this problem and it can be frustrating to treat.
This happens with the tissue under the skin does not heal well and the skin sinks down and heals to the implant capsule. With some women it can improve with massage and cupping, others it is a chronic problem. If non-invasive treatments fail, we can attempt surgical correction with scar revision, fat injections, or a combination of both.
Q: I had breast surgery and my areolas are different sizes, did two people sew me up?
The simple answer is no. Your areola was marked with the same exact marker. Your body frequently heals differently from side to side. The things that affect this are usually differences in how your dissolvable sutures dissolve and how your scar tissue matures. Usually the longer you wait, the more symmetric you will be.
Q: I had breast surgery and my nipple is not in the center of my areolar, did the surgeon do something wrong? Was he/she careless?
The answer to this is also no. This is seen frequently in larger breast reductions. You have a natural contractile ability to your areolar tissue. This is what causes your nipple to become erect when aroused or cold. Sometimes after breast surgery the areolar tissue will not behave properly.
It can either become hyperactive and stay contracted, or the opposite where it doesn’t contract at all. When only one side of the areola does this, it pulls your areola to the side. Don’t worry, this typically improves over 1-2 years after your surgery.
Q: I had breast surgery and my NAC is very sensitive, what can I do?
This is very common, mostly in breast reduction patients. It can be very annoying! It usually will resolve over a 6-12 month period. I find it will be most bothersome in cold environments. The best treatment is to bundle up when it’s cold and do desensitization massage if it is frequent and not associated with cold, happening at random.
Q: My NAC’s are at different levels, can you fix this?
We certainly can, but I always remind patients that a few millimeters of difference is completely normal and chasing something that is normal often ends up with continued unhappiness. Remember perfection does not exist and the mild, normal asymmetries women have are perfect in my opinion!
Q: I lost my NAC from surgery (planned or unplanned result), is there anything you can do?
Yes! Options include 3D tattoo only, nipple creation surgically with areola tattoo, or surgical areola/nipple creation. Your surgeon will tell you which they believe is best for you. I tend to prefer 3D tattoos alone, a surgically created nipple is always erect and can be visible under clothing. See above for my fav tattoo artist. They are not all created equal!
I hope this is helpful, feel free to send me additional questions you have about all things NAC!
After receiving her medical degree from Loma Linda University School of Medicine in Loma Linda, California, Dr. Killeen completed her residency in plastic surgery at the Oregon Health & Science University Hospital in Portland, OR, where she served as Chief Resident.
While completing her residency in general surgery at the world famous Cedars-Sinai Medical Center in Los Angeles, CA, she was recognized for her outstanding academic achievement in surgery, leadership, and clinical performance.
Dr. Killeen specializes in complex breast revisions, breast reconstruction, and breast & body aesthetic surgery. She has a special passion for non-invasive skin rejuvenation and medical skin care.
She resides in Beverly Hills, CA with her husband, two kids, two dogs, and two show cats.