Three-Dimensional Nipple Reduction: New Approach to Management of Nipple Hypertrophy

Goals/Purpose: Nipple hypertrophy is a seldom-discussed topic in aesthetic breast surgery. It is an important condition that often distracts from the overall results of an otherwise satisfactory aesthetic breast surgery. Large nipples that are disproportionate to the areola and breast size can cause significant psychological and physical discomfort. There are numerous techniques for nipple reduction described in literature^1-10. A satisfactory nipple reduction should provide an aesthetically pleasing form without compromising the neurovascular status of the nipple areolar complex and be easily reproducible. The senior author of this paper devised a technique for management of hypertrophic nipples that satisfactorily addresses these criteria. Our presentation will describe the technique, present the results, as well as compare our method to other techniques.

Methods/Technique: Termed "three-dimensional nipple reduction", we have successfully used this technique in eighteen female patients with nipple hypertrophy from 2007 to 2011. All procedures were performed by a single surgeon as an adjunct to other aesthetic breast surgeries, such as mastopexy with or without subglandular or submuscular implant augmentation, as well as augmentation and reduction mammaplasty and breast reconstruction. 

Three triangular-shaped skin markings are made on the nipple (Figures 1 and 2), with apex of the triangle located well below the central mound of the nipple, and the base of the triangle drawn flush with the base of the nipple-areolar interface. Each side of the triangle is angulated outward with the pivot located around midpoint of the limb. The vertical and horizontal reduction is dependent on the length and angle of divergence of each triangular limb. Next, these pre-marked triangular skin wedges are excised at a full-thickness level and then 5-0 Monocryl suture is used to tack down pivot point of the triangular side limb to central area of excised portion at base of nipple. The dog ears on either side of nipple base are excised and several 5-0 Monocryl interrupted sutures are placed to secure the new nipple position.

Results/Complications: All patients were satisfied with the results of nipple reduction and all nipples remained sensate with maintenance of erectile function (Figures 3 and 4). Complications include transient pigmentary changes to the nipples in one patient, over-reduction in one patient, nipple asymmetry in another patient and transient sensory changes in 3 patients with concurrent reduction mammaplasty. We believe that our technique provides for a consistent and an easily reproducible result without a steep learning curve. The technique can be applied safely as an adjunct to other aesthetic or reconstructive breast procedures without adding significant operative times. In addition, our technique provides for reduction in both vertical and horizontal dimensions simultaneously.

Conclusion: We present a novel approach to nipple reduction that provides a simple, reproducible and consistent technique that improves form while preserving function.

REFERENCES

1. Regnault P. Nipple hypertrophy – a physiologic reduction by circumcision. Clin Plast Surg 2: 391, 1975.

2. van Wingerden JJ. Nummular nipple hypertrophy and repair as part of an aesthetic nipple-areola unit. Aesth Plast Surg 21: 408-411, 1997.

3. Sperli AE. Cosmetic reduction of nipple with functional preservation. Br J Plast Surg 27: 42-43, 1974.

4. Vecchione TR. The reduction of the hypertrophic nipple. Aesthetic Plast Surg 3: 343-345, 1979.

5. Ferreira LM, Neto MS, Okamoto RH, Andrew JM. Surgical correction of nipple hypertrophy. Plast Reconstr Surg 1995; 95: 753-754.

6. Lai YL, Wu WC. Nipple reduction with a modified circumcision technique. Br J Plast Surg 1996: 49; 307-309.

7. Cheng MH, Smartt JM, Rodriguez ED, Ulusal BG. Nipple reduction using the modified top hat flap. Plast Reconstr Surg 2006; 118: 1517-1525.

8. Basile FV, Chang YC. The triple-flap nipple-reduction technique. Ann Plast Surg 2007; 59(3): 260-262.

9. Fanous N, Tawile C, Fanous A. Nipple reduction – an adjunct to augmentation mammaplasty. Can J Plast Surg 2009;17(3):81-88.

10. Tuncer S, Eryilmaz T, Atabay K. Correction of nipple hypertrophy: nipple circumcision technique revisited. J Plast Reconstr Aesthet Surg 2010;63(9):1575-1576.

FIGURE 1: THREE-DIMENSIONAL NIPPLE REDUCTION TECHNIQUE

1) red solid line = anterior incision line; 2) red dotted line = posterior incision line

 

 

FIGURE 2: LATERAL AND VERTICAL VIEWS OF THE NIPPLE MARKINGS

1) Red marking = nipple apex; 2) red checkered marks = area of excision; 3) black solid line = anterior incision line; 4) black dotted line = posterior incision line

FIGURE 3: PATIENT 1 PRE- AND POST-REDUCTION IMAGES

38 year-old female pre- and 6-months post-augmentation mastopexy.

FIGURE 4: PATIENT 1 PRE- AND POST-REDUCTION IMAGES

 

42 year-old female pre- and 3-months post-mastopexy.