We have discussed altering the shape and size of the center of the nipple. Today’s discussion will focus on the areola. When we refer to the nipple in common speech it includes the areola. However, for surgical treatment, we tend to focus on the nipple as that central portion of the breast that protrudes above the level of the skin. The rest of the nipple is the darker, larger, flat area around the base of the nipple referred to as the areola. There really is no “normal” for its size and color. We rely on the “eye of the beholder” to decide what the best sized nipple is for each breast.
As surgeons we use “cookie cutters” to outline the center of the areola when we are making surgical alterations. The above is a photo of a couple of those circular tools. They come in all sizes but a rule of thumb is that a 38-40 mm areola looks good on a B-C cup breast, 40-42mm looks right for a breast in the D cup range. A breast that is DD or larger may require a 45mm areola or bigger. Most of the time people getting plastic surgery for their breasts have an A-B cup and are looking to be bigger or a DD or bigger and are looking to be smaller. Therefore most of the time an areola that is 38-42mm in diameter is used.
The mark that is made with the cookie cutter is the new outside of the nipple. All of the extra pigmented skin around this is then removed. A “purse string” suture is used to pull the two circles together as seen below.
This is the technique that is used to reduce the size of the areola and make it a perfect circle. Next time I will discuss one of the 2 different ways of moving the nipple to a new spot.