Nipple reduction is a technique used for reshaping nipples that are overly projecting, and thus often tend to fold over, and sometimes hang downward. This situation is most often seen in older women who have breastfed. Sometimes, men are also affected by hormones changes. It is a simple procedure and can be done under local anesthesia. The procedure may however result in inability to secrete milk in future pregnancies.
A) Ideal nipple esthetics: The ideal nipple is shaped like a cylinder, with a ‘dome-like’ curved top. The ideal projection of a nipple, measured from the top of its dome to its base, is approximately 8 mm (6 mm to 10 mm). In addition, the ideal perimeter of the nipple is approximately 8 mm (6 mm to 10 mm) in diameter.
B) Preoperative marking of the overprojecting nipple: The height of the new nipple is measured as 8 mm from the top of its dome, and a circumferential line ‘p’ is drawn to delineate the perimeter of the new base. Another circumferential line is drawn around the present nipple base ‘b’.
C) Two circumferential incisions are made along lines ‘p’ and ‘b’. The excess skin between these two lines is dissected as a very thin skin flap ‘Sk’ and excised, leaving the lower section of the nipple exposed (pink area). The lactiferous ducts are left intact.
D) Closure: The exposed nipple between incisions‘p’ and ‘b’ is invaginated into the areola. The two incisions ‘p’ and ‘b’ are approximated with interrupted or continuous sutures
Ideally, nipple reduction has to take into account the sensation and the function of the nipple, not just its aesthetics. The procedure should thrive to preserve the nipple’s nerve supply, as well as its network of lactiferous ducts is considered, especially for a woman. The scar recovers well and significantly faded over a period of time.