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