Are you unhappy with the size of your areolas? You are not alone!

When we think of breast surgery it’s usually enlargement, lifts and reductions that come to mind, but what if you’re happy with your breasts shape and size and it’s just your nipple area that is causing you concern? It’s truly a beautiful thing that bodies come in all shapes and sizes and no two bodies are the same, but even though we may be happy with some areas, others can cause us constant concern, affecting us emotionally in a negative way. When we are unhappy with an aspect of our body, it can sometimes have an impact on our emotional well being and affect our confidence.

Why do we have areolas?

Areola is the name for the area of skin around the nipples. It is tougher than regular skin and its function for females is fundamentally to protect the nipple and also when a woman has a baby and chooses to breastfeed she will be thankful for the tougher skin surrounding the nipple as some babies have a powerful sucking motion when they feed and the tougher skin will not only help protect the nipple, but the surrounding area (areola).

Cross section of female breast anatomy showing areola and other areas

Why do areolas differ in colour?

The initial colour of your areola can be predisposed by genetics, but environmental factors can also have an impact such as sunbathing topless may cause them to darken. Change in hormone levels and changes during pregnancy can also greatly impact changes in your body including your breasts, so the colour you have when you’re younger could well change throughout out your life.

Why do areolas differ in shape?

As with all humans we are all unique in our attributes and this goes for our areolas too. The biggest factor in determining the size of your areola is genetics. The size and shape of areolas is highly variable with women generally having larger areolas than men.

The shape of the areola is generally circular, but this can also vary. They can also lack in symmetry too, leaving you with one areola bigger than the other. Your breasts are not always equal in size and so this can also influence the shape of the areolas. Whatever shape you initially have, this can alter through your lifetime. Sexually mature women have an average of 38.1mm (1.5″), but sizes range up to 100mm (4″) or greater.

Why do women have areola reduction surgery?

With every individual it comes down to personal choice about how you feel your body should look. When talking to women about their wish for areola reduction surgery sometimes it can be because it affects their confidence sexually and for others it might be that their body has gone through hormonal changes. Others have talked about the embarrassment they suffer wearing swimwear or underwear as the areola can be large enough that it peaks out of the side or top. They may also have irregular shape, or have areolas with different symmetry to each other.

Whatever the reasons, their lives are being negatively impacted by the relationship they have with their breasts and this leads them to seek out surgical help.

What does areola reduction surgery involve?

Areola surgery involves removing part of the areola to reduce its overall diameter. The breast tissue itself is not affected and depending on the amount of skin to be removed can sometimes make the breasts slightly pert. The areola and nipple position is generally not changed, but this is sometimes not possible depending on the overall size of the existing areola. Your surgeon will discuss this with you in detail. There are various methods of reduction which we use and depending on your existing areola size will determine which is the best option for you. Ideally the scar is placed around the areola as a circular incision.

If the areola is very large, this may necessitate either a two-stage procedure to reduce the size and keep the incision circular; or a single stage with a scar resembling a lollipop (i.e. a circle around the nipple and a vertical line extending from the 6 o’clock margin of the areola down to the base of the breast, where it attaches to the chest, or, inframammary fold).

The procedure is carried out as a local anaesthetic and does not require an inpatient stay. There are dressings placed around the areola and these remain on for up to a week. You are then seen at 1 week after surgery to ensure all is well. We will then see you at 6 weeks and at 3 months from surgery to ensure all has healed as it should.

Will I be able to Breastfeed after areola surgery?

It would be ideal not to have the surgery if you haven’t completed your family, as during pregnancy this can stretch and darken the areola. The ability to breastfeed following areola surgery should not be affected providing the nipple and areola are not removed and reattached. However, if the nipple was removed and then replaced, possible damage to the nerves, milk ducts, may diminish sensation in your nipples and subsequently reduce or limit your milk flow. The nerve supply to the nipples are vital to breastfeeding as they trigger the release of hormones that affect milk production and let-down.

The overall length of time since surgery has an effect also and the longer it’s been since the surgery, the more sensation you’re likely to have in your nipple and areola and the more milk you’re likely to produce. How your milk supply is affected won’t be known until you attempt to nurse your baby. If you still have feeling in the nipple following the surgery and prior to becoming pregnant then you have a much better chance of having a full supply. There are several groups out there who help and guide ladies/couples who have had breast reductions and nipple areola reductions and are nursing or trying to nurse.

Will my nipples still work after areola surgery?

The sensation to the nipples generally come from below and as this area is not dissected, the sensation should remain. Following breast reduction surgery, there is more of a chance of damaging nerves to the nipple as these travel through some of the tissue that is to be removed.

With areola reduction, no tissue is removed so the overall change in sensation does not usually occur. Immediately following the surgery, the sensation will be changed due to the anaesthetic. Over the next two – four weeks, the area will be swollen and this will eventually settle and function should be normal. If the nipple is to be reduced at the same time as the areola, then this can sometimes disrupt the anatomy.

Will there be visible scars?

The scars tend to be quite subtle. There are a number of ways the scars can be placed, depending on the amount of tissue that needs to be removed. The scar can be placed around the base of the nipple and will be hidden. The scar can be placed just inside the irregular margin and therefore result in a more natural result; or it can be placed at the edge of the areola forming a more circular scar. The method of surgery will be determined at the time of consult.

See a 1 month comparison of before and after Areola Reduction surgery

What is the recovery period?

Following areola reduction, the wounds will take about two weeks to heal. The overall strength of the wound will not reach a maximum until about 4 weeks. After this time, the strength of the wound will be around the maximum it reaches and you can start massaging the wounds. You should avoid heavy exercise for two weeks and then increase the amount you are doing slowly from two weeks up to 6 weeks. At this stage you can start back at the same level as before your surgery.