NIPPLES AND AREOLAS
When they are in harmony with size, shape, and position, the nipples and areolas are the main structures that transform the breasts as fundamental parts of a woman’s beauty, femininity, and sensuality. Through them, mothers nourish the child that is born. They are important in breast self-examination to detect if there is any problem. In the plastic surgeries of this region, they are essential structures that allow access to the inside of the breast and their tissue has excellent healing.
WHAT IT IS AND HOW IT IS DONE
The plastic surgery done on the Nipples and Areolas can correct a series of imperfections. Nipples that are too big, non-existent, inverted or double. Areolas that are too big or too small. In some women, these alterations can be caused by genetic characteristics, hormones, diseases and after breast-feeding.
The procedure can be performed separately to harmonize anatomical imperfections, asymmetries and disproportions in these structures of the breasts, but many times it is associated with the plastic surgery Reduction Mammaplasty or Mastopexy.
When done alone, the surgery lasts an average of 1 hour, according to the planned correction. It can be performed with local anesthesia associated with light sedation. When associated, the surgery lasts at least 2 hours and with general anesthesia.
When indicated, after detailed exams to verify the effectiveness of the Nipple correction surgery – in a way that preserves the sensibility and great part of the channels through which the mother’s milk passes – we use the following strategies to correct its imperfections:
Reduction: If they are long or extensive, we make two parallel incisions around the nipple near the areola to remove a ring of skin. If they are thick or have proportionally large diameters, we remove part of it with incisions from the center to the edge (pizza shape). If they are long and wide, we can opt for an association between these two strategies.
Reversal: To reposition the nipple outwards, if it is inverted towards the inside of the breast, we make an incision in the middle of the areola, through which we break the ligaments that hold it in place.
Union: For cases of double nipple (bifidus) in the same areola, we make the incisions to remove the central portion that separates it in two and suture it in one.
Creation: For cases of congenital absence or loss of the nipple due to some disease (for example, breast cancer), we can use techniques of reconstruction of this structure using the skin of the areola itself and/or local breast tissues (skin and fat).
When the Areola correction surgery is indicated, we use the following strategies to correct its imperfections:
Reduction: If the diameter is proportionally large, we remove a circular-shaped portion from the edges to the center of the areola, approximate the skin and suture. With this strategy, it is also possible to correct irregular borders.
Augmentation: If the goal is to enlarge the areola, the circular-shaped portion that we remove is the skin around it. Then, we perform the areola tissue expansion and suture. In this case, we take every care with the risk of scar enlargement.
When the planning involves the complete reconstruction of the areola and nipple – after a mastectomy, for example – we can use some strategies according to the case. The areola can be done with skin grafts taken from the groin or from the armpit, or through tattooing. As for the nipple, we can use skin from the earlobe, local flaps from the breast itself, or nipple grafts from the other breast, if available.
After the sutures, special dressings are applied, which vary according to the surgery performed.
Important: If you feel any difference in the nipples and areolas, such as lumps, secretions, skin dimples and changes (crusts, peel formation, hardening and/or sudden inversion), seek a doctor for an evaluation.
INDICATION
Nipples and Areolas corrections procedures can be performed by women who feel uncomfortable with their aspects, symmetries and sizes, and also by women who rebuild their breasts after mastectomy. They are indicated for women with fully developed breasts, usually after the age of 16.
When the nipples and/or areolas are in disharmony with the breast, they can directly affect the woman’s (and, also, the man’s) self-esteem to the point of limiting his social activities and even causing relationship problems.
In the case of men, the exaggerated growth of the areola is associated with Gynecomastia.
PREOPERATIVE
It is essential to consult the SCHEDULED THE SURGERY? page which has a series of questions to talk about during the consultations, to help you with your doubts and where you will find recommendations for the day of the procedure.
If you have, it is important to talk about family history of breast cancer and bring the latest results of previous mammograms or biopsies.
If the Nipples and Areolas correction surgeries are performed in association with other breast procedures, the pre and postoperative recommendations of these procedures apply.
POSTOPERATIVE
The length of stay after surgery is 12 hours (Dayhospital). The pain is not usually very bothersome, but you will probably feel it for a few days while the swelling starts to go down. The first 2 days should be absolute rest, which is essential for healing. Sleep with your stomach up, with your arms at your sides and your torso elevated to be more comfortable for at least 2 weeks.
Usually, we change the first dressing and teach the rest to be done by the patient at home. The use of a post-surgical bra helps to protect, hold, and shape the breasts. It must be worn for 3 months, taking it off only for bathing and dressing. In the first 2 weeks, avoid any abrupt touch or friction on the breasts.
Opt for lighter food on the 1st day (fruit, soup, gelatin, fiber, liquids, etc.). From the 2nd day of the procedure on, we suggest a balanced diet rich in fruits, vegetables and white meats. Avoid sweets, fried food, soft drinks and alcoholic beverages. Hydrate yourself a lot. Use the minimum of salt so as not to increase swelling.
After the 3rd day it is already possible to return moderately to daily activities, but without physical effort. Light walks from the 7th day on are allowed; more intense physical activities, after evaluation. Avoid heavy lifting, do not raise your arms above your shoulders or open them too much for at least a week, the same time without driving.
Avoid as much as possible exposure of the scars to the sun for at least 6 months. Afterwards, always use sunscreen with a minimum of 30 SPF (sun protection factor).
There is some alteration in sensitivity during the first months, which regresses in most cases. The planned results are reached between 6 months and 1 year after the surgery because this is when the scars, which can be very discrete, are mature and clear. The results remain longer if you maintain your weight and maintain a healthy lifestyle.