Mommy Makeover: Season 1 Episode 3

The Areola

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.


Mommy Makeover: Season 1 Episode 2

Nipple Inversion

With pregnancy and breast-feeding sometimes the opposite of enlarged nipples can happen. This is termed “inverted nipples.” This happens when the ducts of the breast do not stretch to keep up with the breast growth. Oftentimes, this becomes a permanent problem especially if the breast does not return to its original size.

There is a simple solution for this. After breast-feeding is finished, the nipple can be recovered by dividing the ducts.

Step 1

                           

This office procedure involves numbing the nipple first with ointment and then with an injection. If this is done with patience there is no pain involved.

Step 2

After the nipple is numb an 11 blade scalpel is used to divide the ducts.

Step 3

Then a device is used to hold the nipple in its new position so that it will heal properly. When done correctly the new appearance of the nipple will be maintained long term.

After the procedure it is possible for normal sensation to return. However, sometimes nerves are injured and sensation may be reduced. After this procedure it will not be possible to breastfeed again. If an unplanned pregnancy occurs then when the milk comes in it will go away similar to when you quit breastfeeding as there is no outlet for the milk.

Next episode we will talk more about changes to the nipple from pregnancy. Specifically the size shape and color of the areola and what can be done to improve it.


Multi-Part Series: Mommy Makeover Season 1 Episode 1

👋 Dr. Bruggeman here.  I will be writing all the content for this blog myself.  This will give me a chance to offer mini-consults through the internet. There will be photos involved so that you can compare the things discussed here to yourself or someone you know.  All of the photos are mine unless otherwise specified.  There’s no substitute for an in person consult but this will be an effective way to help you decide if a consult is worth it.

What is a Mommy Makeover?

I’ll begin with a multi-part series that covers Mommy Makeover . A mommy makeover can be a confusing term because it covers a lot of different things.  Basically the term applies to the correction of any of the negative changes that happen to your body after having a baby.  Mostly this involves the change in size and or drooping of the breasts.  Another major body area of concern is the abdomen.  It experiences a lot negative effects from the increase in overall size and stretching of the skin.  Also, with childbearing there is weight gain that is healthy for you, and the baby as well, but sometimes it can be difficult to lose the unwanted weight after pregnancy.  These areas are often good targets for liposuction and skin tightening modalities.

Starting From the Top Down- The Nipple

Let’s start from the top down.  Today’s topic will begin with the nipple.  It is usually positioned on the top and in the center of the breast.  It may be the first thing that is noticed when you look at your breast.  With breast feeding the nipple can change.  It may change positions, usually to a lower part of the breast, this contributes to the droopy appearance referred to as “ptosis.”  Also, the size of the areola and the nipple itself can change.  If the nipple maintains a disproportionately large size after the breast’s volume has gone away it can be fixed.  Often times the size or shape off the nipple is a topic that gets overlooked in consults because patients may not be aware that anything can be done safely, or the doctor may assume that if the patient doesn’t bring it up then they must be happy with it.

 

The above photos are examples of enlarged nipples that detract from the overall aesthetic appearance of the breast.  The procedure used to reduce the height of the nipple is safe and can be done in the office with local anesthetic.  As you can see here nothing is amputated and no nerves or ducts are severed, because the reduction comes from excising the excess skin around the nipple.  Sutures are placed to bring the height of the nipple down. Any size can be selected for your desired end result.

                             

Here are examples of two different heights resulting from the same procedure.  The sutures are left in place for 1-2 weeks.  The sensation and the ability to breast feed in the future remain intact.

Season 1 Episode 2- COMING SOON!