Can you have your nipples shrunk?

[coll83]

I know it sounds amusing, but I had surgery about 5 years ago and they removed all the fat from under my massively puffed up nipples. However, the nipples are still the size they originally were and so they still look much too big for my chest. I never take my shirt off in public unless I am either freezing cold, fresh from a workout in the gym or I have been tweaking my nipples prior.
I would love to be able to walk about topless during the summer but there is no way I can be comfortable like this. They sag a bit if I am not flexing my chest too, and look very womanly. Can the nipples be made smaller without leaving hideous scars?

Thanks for any help.

[DrBermant]

I know it sounds amusing, but I had surgery about 5 years ago and they removed all the fat from under my massively puffed up nipples. However, the nipples are still the size they originally were and so they still look much too big for my chest. I never take my shirt off in public unless I am either freezing cold, fresh from a workout in the gym or I have been tweaking my nipples prior.
I would love to be able to walk about topless during the summer but there is no way I can be comfortable like this. They sag a bit if I am not flexing my chest too, and look very womanly. Can the nipples be made smaller without leaving hideous scars?

Thanks for any help.

Large Areola Reduction Surgery is a significant compromise that I rarely recommend unless there is a great deal of excess skin (such as After Massive Weight Loss or in large breast Transgender Female to Male Chest Contouring.) There are many techniques to tighten the skin and remove areola, each has their own compromises.  However, flat nipples hanging well below the pectoral muscles look much worse than scars from reduction.  For major amounts of excess skin, a Skin Reduction Chest Lift may be an option.  Depending on sutures to hold areola tissues at a smaller size is a real risk as seen in the example below where I revised a mess from Australia surgeon's use of dissolvable sutures.  Permanent sutures can break, stretch, and get infected.  Such risks are better explored during a consultation after an evaluation.

Warning Graphing During Gynecomastia Areola Reduction Surgery Pictures

You can see actual pictures during a  Revision Donut Mastopexy Areola Reduction Surgery here. 

Photographs during surgery to reduce big areola continue here. and there are more Pictures during surgery to reduce male areola here.

The areola usually expands with bigger breasts.  Like a balloon, with deflation (surgery) there is a reduction in diameter. However, a balloon can deflate and the diameter not change. Check out the second and third photo sets in that gallery link to see what I mean. One of the causes of failure of shrinkage can be a layer of remaining gland after gynecomastia surgery.  Roll your cursor over that text or image and you can see a drawing of gland that can be left behind after surgery.  I have seen many examples of gland adherent to the muscle areola complex that keeps the areola puffy and larger diameter.  That is why I prefer to target the gland first with my Dynamic Technique for Gynecomastia.

Check out the many before after pictures of this  Areola / Nipple Reduction Gallery, Areola Reduction Picture Gallery, and Pictures of Areola Reduced with Gynecomastia Surgery.  These results are typical for my sculpture of my patients.

Here is a balloon demonstration of nipple / areola shrinkage typically seen with my gynecomastia surgery.  When a breast gets bigger, so does the diameter of the areola nipple complex.  Remove tissue from the breast and it is like this balloon deflation.  However, not all tissues shrink the same.  Tissue over stretched, older patients, scars, and gland remaining after gynecomastia surgery can limit this decrease.  Here is a demonstration of deflation with areola staying the same size.  That is why I prefer to target this gland first with my surgery.

Take your time to browse through the galleries of nipple areola pictures before and after gynecomastia surgery to see actual results for my patients.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Contouring

[DrBermant]

Hello,

Been thinking whether there is a surgery out there for men to actually have their entire nipples reduced in size. I don't mean through removal of fat tissue lipo and gland route where the nipple would retract back towards the body, I'm thinking like a total reshape of the nipple - the width and size.. So from a pepperoni sized nipple to a pea sized one! (maybe not that small, but you get the idea)

Is such thing available? Does it arise with complications or odd looking effects? I'd be interested to know as only heard of the lipo and gland means of procedure

Please advise, thanking in advance

In most cases there is a beautiful reduction in nipple areola diameter that I see by targeting gland first. Areola reduction surgery scars are a significant compromise that you can better understand when actually seeing an actual demonstration. I have seen several patients with the Large Areola Complication when other surgeons tried to reduce the areola when, in my opinion, it would have been better left alone.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[Dr. Elliot Jacobs]

I agree with Dr Bermant.

In virtually every gyne operation, the skin  will tighten and the areolar diameter will diminish -- in a range of 10-20% decrease in size.  Of course, this depends on the natural elasticity of the skin, which diminishes with exposure to the sun, smoking, age and presence of obesity (at present or in the past).

I have witnessed very significant decrease in areolar diameters with gyne surgery alone -- and I frequently caution my patients to wait and allow everything to settle down (usually around 6 months) before considering further attempts at areolar reduction.  Bear in mind, reducing the areola further will require an incision completely around the areola.  I very rarely do this because my patients are satisfied with the reduction that the original surgery provided.

If indeed further areolar reduction is performed, there is a high chance of spread-out scars and eventual spreading and/or distortion of the areola as well.

Dr Jacobs

[DrBermant]

I agree with Dr Bermant.

In virtually every gyne operation, the skin  will tighten and the areolar diameter will diminish -- in a range of 10-20% decrease in size.  Of course, this depends on the natural elasticity of the skin, which diminishes with exposure to the sun, smoking, age and presence of obesity (at present or in the past).

I have witnessed very significant decrease in areolar diameters with gyne surgery alone -- and I frequently caution my patients to wait and allow everything to settle down (usually around 6 months) before considering further attempts at areolar reduction.  Bear in mind, reducing the areola further will require an incision completely around the areola.  I very rarely do this because my patients are satisfied with the reduction that the original surgery provided.

Dr Jacobs

For years have been documenting this issue by measuring the nipple areola complex before and after surgery. I take measurements of the

• long axis
• short axis
• angle the axis varies from the horizonatal
• height projection

I perform this measurement with calipers.

Just like Dr. Jacobs mentions I see an areola shrinkage with surgery. Just how much the areola shrinks, I think is technique dependent. By targeting gland first in every case where there is a gland contour component, the differences can be really radical. The tissues of the nipple areola complex can attach to the gland just at the anatomic nipple or more commonly through a diffuse attachment to the edge of the areola and beyond. When this gland attachment remains behind, the nipple areola can be forced to the larger remaining gland size. The remaining gland can also be one of the causes of the term I coined Residual Puffy Nipple Deformity, where the shape of the areola maintains the gland shape and size.

The changes I was seeing were so dramatic, that I started using the calipers on the patients' chest in front of a mirror to show the differences. This became a component of my program for the emotional healing component for each patient who permits me to take off the dressing in my office or who returns for a long term followup.

Large Gland Removed through tiny 1.6cm incision.

Puffy Nipples Before Surgery

Calipers Set to Before Surgery Dimensions

Calipers Set to Before Surgery Dimensions

Notice the radical change in size and shape of areola. In some dimensions we have been recording a 70 percent decrease in size of some of the dimensions. There is also a concentration of pigment color. The same number of color cells in a smaller results in a darker areola.

I prefer to start the emotional healing component as quickly as possible. What becomes fun is seeing the expressions on the faces of my patients as they look at the mirror seeing what changes have happened. This has gone way beyond the documentation of a technique, it has become part of the healing.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[DrBermant]

Large Gland Removed Through Tiny Edge Areola Incision.

Puffy Nipples Before Surgery

Calipers Set to Before Surgery Dimensions

Calipers Set to Before Surgery Dimensions

The after surgery images are only 7 days after surgery. The steristrips are there for both wound support and areola splinting.

I am sorry that the patient holding the calipers for the pictures could not maintain the edge of the calipers at the edge of the areola. When I am demonstrating the effect, I am holding the instrument myself. But it is hard to do the pictures and hold the calipers at the same time.

These are not exaggerations nor manipulation of pictures, just an amazing deflation of nipple areola gland deformity achieved by targeting the gland first.

The vertical deflation measurement or pictures is even more dramatic. For that measurement, I have the patients look down at their chest with the caliper set in place. Here is an example from the prior post patient's projection change:

Calipers Set to Before Surgery Dimensions


Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[zazzy]

Nice work Dr.Berment. I am impressed that there are almost no surgical spots after the surgery.

The pics you have posted totally encourage me to undergo a surgery from your place as well. However this will be 5-6 years from now, in that time i will collect the required amount.

[DrBermant]

Nice work Dr.Berment. I am impressed that there are almost no surgical spots after the surgery.

The pics you have posted totally encourage me to undergo a surgery from your place as well. However this will be 5-6 years from now, in that time i will collect the required amount.

Thank you for your kind words. Selection of surgeon by evaluating images and actual examples of his / her technique can be a critical component of the process of learning what any doctor offers.

However, I will be retiring the end of August 2011, so it will not be with me in that time frame.

Hope this helps,

Michael Bermant, M.D.