Changing the Position of the Areola
Last time we discussed making the areola smaller and more round. Today I will discuss 2 major techniques for moving the nipples. After pregnancy, if the breast becomes deflated and sags then the nipple can be repositioned higher with a technique that is similar to the one previously described. An oval is drawn around the inner circle that is marked. As these patterns are brought together the nipple will move up to 3 cm in the direction that the oval is oriented. The following is the markings of the pattern described and a one week result in a patient that I performed it on.
Free Nipple Graft
If during pregnancy the breast increases massively in size and never returns to normal the nipple may need to move so far that it can’t be done without detaching it. This is called a free nipple graft. The nipple areola are marked with the cookie cutter and the nipple is removed with a scalpel. Next the nipple is thinned to the perfect thickness and it is sewn back on in a spot that has been deepithelialized in a shape that matches. The following is an example of nipples that have been removed and thinned.
Patients are warned that sensation will be lost after this technique. However, some patients have told me that it eventually did come back for them.