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Archive for the ‘nipple reduction’ Category

Case Study – Mushroom Male Nipple Reduction

Saturday, July 15th, 2017


Background: The existence of the nipples in a male is from its embryological development. Since all embryos start out as a female, the existence of the milk lines and the nipples develop before the embryo’s sex has been determined. Once the Y chromosome and testosterone levels make it into a male, the nipples are already present. While female nipples go on to become functional, male nipples are vestigial. Men may look peculiar without them but they have no functional purpose.

The nipples in men are usually taken for granted unless they develop a tissue problem. One of these tissue problems is hypertrophy of the nipple. A protruding or elongated nipple is annoying to most men. It may rub on shirts and get irritated due to tissue chafing. They may also be evident in shirts and be a source of embarrassment. Often both nipple problems occur together.

The diagnosis of an elongated nipple must be differentiated from areolar protrusion or areolar gynecomastia. An isolated elongated nipple has a flat arealar and chest contour around it. Areolar gynecomastia  is when the entire areola is enlarged or puffy. It may or may not have an elongated nipple associated with it.

Case Study: This 35 year-old male was bothered by his elongated nipples which were a source of embarrassment. He had an otherwise flat chest profile.

Under local anesthesia, the nipples were elliptically excised around their base and a core of underlying ductal tissue taken with it. To achieve a completely flat areola, some of the deeper tissue must be taken. The removed nipples resembled a mushroom on their shape. The inner areolar margins were closed with dissolvable sutures.

For most men nipple reduction should really be called nipple removal. While the nipple has a different color and contour to the areola, most men with protruding nipples do not care if any nipple is left at all. The main goal is the assurance that any nipple protrusion is completely eliminated. The mushroom nipple reduction technique assures that a completely flat areolar contour is obtained.


  1. Protruding nipples in a male is often both a source of irritation and embarrassment.
  2. Male nipple reduction usually consists of complete nipple removal.
  3. The mushroom make nipple reduction ensures that the external protruding nipple and the underlying ducts are removed to ensure a complete flat profile.

Dr. Barry Eppley

Indianapolis, Indiana

Male Nipple Reduction

Friday, May 22nd, 2015


While men have nipples just like women, they serve no functional purpose. Men do not get pregnant nor do they have to breast feed so the role of the nipple-areolar complex is essentially decorative. While men may look peculiar if they did not have nipples, because we are used to seeing all humans with them, they are present in men as a result of pure genetics. The XY chromosome that men have does not start emitting testosterone until over a month into pregnancy. But up until that point the embyro acts like a female, creating nipples which persist even after the male develops more masculine features such as testicles and a scrotum.

While the make nipple serves no purpose it can be a source of irritation. Protruding nipples can be a source of embarrassment both in and out of shirts and can also end up irritated and sore due to abrasion on clothing. I recently watched the end of the Indianapolis marathon and saw several men who had actual blood on their shirts from chronic nipple irritation that eventually caused them to bleed. I would imagine it would take days for such nipple ‘sores’ to eventually heal and become non-tender.

Male Nipple Reduction Surgery Dr Barry Eppley IndianapolisMale Nipple Reduction Surgery Results Dr Barry Eppley IndianapolisThe good news is that protruding male nipples can be very effectively and simply reduced to provide a permanent resolution to these concerns. Under local anesthesia the nipple can be reduced through a vertical wedge excision at its base. This is actually closer to a ‘nipplectomy’ or complete nipple removal so that only the surrounding areolar base is left. For most men this is a very acceptable trade-off since they want the flattest nipple profile as possible. Since the nipple is usually a lighter color than the surrounding areola, close inspection may be able to detect that there is actually little to no nipple present. But this minor aesthetic alteration is irrelevant to those men affected by the symptoms of enlarged nipples.

Indianapolis Male Nipple Reduction Dr Barry EppleyMale nipple reduction provides an immediate and permanent solution to an anatomic structure whose presence is a mere quirk of a brief genetic window in utero. In less than an hour the procedure can be completed. Dissolveable sutures are placed so no followup for suture removal is needed. One wears bandaids for a few days, can shower the next day, and does not need any after surgery restrictions of activities.

Dr. Barry Eppley

Indianapolis, Indiana

Female Nipple Reduction Surgery

Saturday, January 10th, 2015


Nipple concealers Dr Barry Eppley IndianapolisProtruding nipples can occur because of they naturally develop, induced to grow by pregnancy and breastfeeding, or inadvertently become more obvious by the placement of breast implants. Nipple hypertrophy can be managed by a variety of  products to help flatten and hide their prominence. These are usually circular silicone shields which, when applied to your skin, stay in place and help conceal your nipple in clothes. They are relatively inexpensive and go by such interesting names as ‘low beams’ and ‘top hats’.

But having to be constantly on guard about nipples that appear through clothes can be solved by a simple operation. Nipple reduction is a procedure which surprisingly some women are unaware. The procedure removes a portion of the nipple to make it smaller and is usually done under local anesthesia. The main goal is to reduce its length which makes it less prominent. In shortening the nipple it may also become more narrow in width.

Nipple Reduction Wedge Technique Dr Barry Eppley IndianapolisNipple reduction is done by two basic techniques. Removal of a pie-shaped wedge of nipple tissue is the most common method and can produce the most dramatic change in nipple length. Because it removes a portion of the actual nipple, some sensation may be lost. The other nipple reduction technique is to remove a circular ring of nipple from its sides. This technique is best used for this women who are concerned about any loss of nipple sensation.

Besides the risk of loss of nipple sensation, nipple reduction may make it harder to breast feed. Depending on the technique used you may not be able to breast feed if the terminal openings of the breast ducts become scarred. (like from a pie-shaped wedge of nipple reduction technique) This nipple reduction surgery should be deferred until after having children for women who are interested in breast feeding in the future.

Female Nipple Reduction intraop result Dr Barry Eppley IndianapolisNipple reduction surgery can be performed concurrently during any other breast procedure from having implants to undergoing a breast reduction. But of there is any doubt about whether nipple reduction needs to be done, deferring it to later does not cause a problem. It can always be done in the office later under local anesthesia.

The need for nipple reduction is a subjective one. Nipples that are easily detectable in thinner bras or under clothing without a bra can be a source of embarrassment. The good news is that this is a problem which can be simply solved in less than thirty minutes.

Dr. Barry Eppley

Indianapolis, Indiana

Nipple Reduction Surgery in Men and Women

Sunday, December 15th, 2013


The size of the nipple on a man’s or woman’s chest is often unnoticed, until it becomes too long. A long nipple, known as nipple hypertrophy, can be both a source of embarrassment and irritation. It can be challenging to hide under light clothing and leads to chronic irritation and chafing from rubbing against clothing. For these reasons, both men and women seek nipple reduction surgery.

Nipple hypertrophy (macrothelia) is more frequently seen in Asians and less common in Caucasians. Why a nipple grows long is not known. There is some familial association to it and it can appear after adolescence or following pregnancy. It is almost always bilateral although one-sides long nipples do also occur. Once it develops, the long nipple persists throughout life and does not recede.

The nipple has a specific set of desired shapes and sizes. The ideal nipple has a cylinder shape with a “dome-like” top with projection between 6-10mm in women and between 3 and 6mms in men. . The nipple in women can be aesthetically tolerated to be longer in women than in men. and is often naturally so for the obvious reason for or as a result of breastfeeding. However, in cases of nipple hypertrophy lengths can be up to 2 cms in women and 1 cm in men.

Nipple reduction surgery is relatively simple given the small surface area of its projection. When planning for a nipple reduction surgery two factors are important to take into account for women, nipple sensation and preservation of lactation. For men, none of these functional issues apply. Procedures available include the classic wedge amputation technique which involves excision of the nipple core that cuts through the lactiferous ducts and disrupts lactation as well as reducing nipple sensation. There is also the sleeve resection method where a strip of tissue is removed from the base of the nipple without cutting across its core. This nipple reduction method preserves nipple sensation and theoretically preserves lactation as it does not disrupt lactiferous ducts.

Male Nipple Reduction Surgery Results Dr Barry Eppley IndianapolisMale nipple reduction always uses the wedge reduction technique as men want as flat as nipple as possible. It is not important to them whether any residual nipple projection is left nor is preservation of sensation an issue. While the wedge reduction technique is simple, one has to be careful to not take too large of a wedge as an inversion deformity can result. Loss of the color difference between the nipple and the areola will occur although this is not an aesthetic concern. It can be comfortably done as an office procedure under local anesthesia.

Female Nipple Reduction Dr Barry Eppley IndianapolisFemale nipple reduction can use either the wedge or sleeve reduction methods. The choice often depends on how much excessive nipple length exists, whether it is bilateral or on just one side and if no further pregnancies are planned. Wedge nipple reductions in women are easier than in men because some residual nipple length is maintained. Sleeve reduction methods are more technically precarious as maintaining a central core of tissue is essential for nipple survival. Nipple reduction can be safely combined with breast augmentation or breast lifts.

In summary, nipple reduction is very effective and the scars are hidden in the nipple-areola junction. It has  no real recovery and can be safely combined with an other forms of breast or chest enhancement surgery.

Dr. Barry Eppley

Dr. Chris Ueno

Mini-Mommy Makeover Procedures

Sunday, May 19th, 2013

The concept of a Mommy Makeover plastic surgery procedure is about combining abdominal and breast reshaping in one operation. The breast and abdominal components are not new and include many well known procedures such as tummy tucks, breast implants, liposuction and breast lifts in whatever combination each individual women needs. While the effects of a Mommy Makeover can be dramatic, breast and abdominal procedures are major surgery with significant recovery as well.

But there are numerous other procedures of lesser magnitude that could also be lumped into the Mommy Makeover category and consist of a variety of ‘nips, tucks and sticks’ that create effects that mothers would also like. Here are some of the most noteworthy.

BOTOX  For reduction of those facial expression lines that come from the stress of balancing mother and wife roles, Botox injections are probably the most common injectable Mommy procedure.

Vi/PERFECT PEELS With only a few days of redness and flaking, these medium-depth facial peels are essentially painless to go through and provide a real boost to one’s complexion. A few of these a year will keep a mother’s skin radiant and glowing.

C-SECTION SCAR REVISION For those women that don’t need a tummy tuck and have a noticeable c-section scar with just a little pooch above it, widely cutting out the scar can produce a flatter upper pubic area. This scar revision can be combined with some lower abdominal liposuction for an additional and wider flattening effect.

UPPER LIP PLUMPING Some well placed Restylane or Juvederm injections into the upper lip has an instant youthful volumizing effect. This is particularly evident if the cupid’s bow and philtral columns are accentuated.

NIPPLE REDUCTION Breast feeding can elongate the nipple which can be a source of embarrassment and out of proportion to the size of the areola. Under local anesthesia, the nipple length can be reduced by half or more.

EARLOBE REPAIR Fixing stretched out ear ring holes or complete tears through the lobe can allow old or new ear rings to be comfortably worn again.

BELLY BUTTON REPAIR (Umbilicoplasty) Pregnancies can change an innie belly button to an outie due to a small hernia through the umbilical stalk attachment. Tucking the peritoneal fat back through the hole and reattaching the stalk of the belly button back down to the abdominal wall will recreate that an old inne look again.

EXILIS For those stubborn fat areas that just won’t go away despite some diet and exercise, this non-surgical fat treatment can easily fit into a busy mom’s schedule. It takes a series of treatments to see the effects but there is no downtime with 30 minute in-office treatment sessions.

These mini-Mommy Makeovers provide changes that do not require major surgery or recovery and can fit into anyone’s hectic schedule.

Dr. Barry Eppley

Indianapolis, Indiana

Male Nipple Disorders and Their Surgical Correction

Monday, July 16th, 2012

The size and shape of a man’s chest can be a source of pride or embarrassment. Much emphasis on the aesthetics of a masculine chest is based on the pectoralis muscular anatomy. While this muscle provides support for the overlying skin, and clearly its size and border outlines are important, the lone remaining aesthetic feature is that of the nipple. While a man’s nipple is usually much smaller than a woman’s, it can have numerous aesthetic deformities which are both bothersome and embarrassing.

The male nipple has the same anatomic features as that of a female, a centrally elevated nipple and a surrounding areola. Men typically have much less nipple projection, even when stimulated, and a thin width to the surrounding areolar circle. This is no surprise given that it has no lactation function and has no purpose in being any larger. But despite its small size, it can have a series of aesthetic problems that men would like improved.

Nipple protrusion, or the overly projecting nipple, is a frequent source of male embarrassment. For some men, the nipple sticks out all the time. For other affected men, the protrusion is only bothersome as it occurs with stimulation, particularly when one is cold. Sticking out through shirts is the common complaint which brings men in for a nipple reduction procedure. Men want a completely flat nipple that does not become erect at all. A nipple reduction is a simple procedure that is performed in the office under local anesthesia. To be more accurate, it should be called a nipple amputation or nipplectomy. While a nub of nipple can be retained, most men want it completely gone and flat. Removing the nipple through a wedge excision to include the ducts and bringing the areolar edges together is the surgical technique.

A different form of nipple protrusion is that of the puffy nipple. The puffy nipple is not protrusion of the nipple but that of the entire nipple-areolar complex. This is caused by breast tissue pushing out from behind. This is known as areolar gynecomastia, a small form of breast tissue enlargement that causes visible projection of the overlying nipple. This is commonly seen in young men who desire a completely flat chest profile. This is treated by an open excisional approach through a lower areolar incision. The breast tissue is directly excised and feathered into the remaining breast tissues beyond the areolar margins. This is the smallest form of gynecomastia that is treated. Care must be taken during the procedure to not over-resect the breast tissue, causing a nipple inversion problem later.

The sagging or ptotic nipple is a problem of older males. As the chest tissues lose volume and sag, the nipple sits much lower on the chest wall. This is caused not by the nipple sagging per se, but by the entire chest skin on which it sists falling off of the muscle and ribs so to speak. This can be improved through a nipple lift procedure. By removing a crescent of skin above the nipple, the nipple is lifted upwards into a higher position. There is a limit to how much movement can be done, often being no more than 10 to 15mms upward. While greater upward nipple movement is possible trough different patterns of skin excision, this results in scars that extend downward from the nipple. This is usually not an acceptable trade-off for most men.

Nipple asymmetry can also occur due to either congenital deformities or some more natural amounts of chest asymmetry. Nipple asymmetries can occur in either horizontal or vertical dimensions. Most commonly, it is the difference in their horizontal positions that is disturbing. It can involve just one nipple or both. Based on the movements needed to move the nipples to more symmetric positions determines where on the nipple circle the crescent skin excision is oriented. Often moving both nipples, splitting the difference in the asymmetry, is the best way to get the most symmetric result.

Male nipple deformities can be easily treated and improved, many of which can be treated  under local anesthesia with virtually no recovery.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Reduction of the Prominent Nipples in Men

Saturday, August 28th, 2010

Background:  The nipple, technically known as the nipple-areolar complex, is present in both men and women. While it has a functional role in women, it is a non-functional vestigial structur in men. While a man’s chest would look strange without it, it aesthetically should blend in and be relatively non-prominent. Changes in the size and shape of the nipple are undesireable.

One of the undesireable topographies of the nipple is when the nipple is too long or enlarged.  Rather than having a fairly smooth chest contour across the nipple’s surface, a prominent nipple creates an obvious two-tiered structure. This not only sticks out and is obvious when one is bare-chested but protrudes through shirts. ‘High beams’ in men is particularly bothersome to most men and is a source of embarrassment. Concerns about a prominent nipple can affect what type of clothes to wear.

Case: This is a 24 year-old male who was concerned about his prominent nipples. He said they were not always so and had appeared just a few years ago. They stuck out all the time and he was not comfortable wearing any type of form fitting shirt. Exposure to cold made them stick out even further.

In discussion about their reduction, he was not concerned about whether any feeling remained in them. He was most concerned that they were as flat as possible and did not have any noticeable scarring. Two techniques for nipple reduction were reviewed, wedge excision and circular or donut reduction. Wedge excision nipple reduction is essentially an amputation method where it is completely removed. It will make the nipple completely flat (because it is gone) but there will be no tiny mound or slight raised area where the nipple would normally be. The invisible scar will have the same tissue characteristics and scar as the surrounding areola. The circular method removes a ring of nipple tissue at its base and shortens it. This will not make it flat and will leave a smaller raised nipple mound. Feeling in the nipple may be maintained after.

Under local anesthesia in the office, the nipples were removed by wedge excision that were vertically oriented. The excised area was closed with small dissolveable sutures. The only dressings applied were glued on tapes that only covered the diameter of the areolas. The entire procedure was completed in 30 minutes.

The results are immediate without swelling or bruising. There are no restrictions from any activity after surgery. One can shower, swim and workout the very next day. The results will be permanent as the nipple can never grow back.

For those men, young or old, that are bothered by a long or prominent nipple can quickly solve this problem without pain, recovery, or prominent scarring.

Case Highlights:

1)      Nipple protrusion in the male is a source of embarrassment and usually develops after puberty in most cases.


2)      The wedge excision (amputation) technique of nipple reduction is usually preferred as it assures that the nipple will be completely flat.


3)      Nipple reduction surgery is a simple office procedure done under local anesthesia. There is no recovery or physical restrictions after the procedure.


Dr. Barry Eppley

Indianapolis Indiana

Nipple Reduction with Breast Augmentation

Saturday, July 25th, 2009

While the placement of implants makes the breast larger, they will also make the nipple expand as well. This is a simple phenomenon of tissue expansion. As the overlying breast skin stretches to accomodate the size of the implant, so must the nipple-areolar complex become expanded as well. It is reasonable to expect, therefore, that one will have postoperative nipple changes.

This is rarely an issue or concern for the vast majority of breast augmentation patients. As the size of the nipple correlates with the size of the natural breast, most candidates for breast augmentation have only small amounts of natural breast tissue and small nipples as well. After the insertion of breast implants, the nipple stretches somewhat proportionate to the increase in breast size and it remains with a fairly balanced look. In actuality, the nipple size (width) never increases as much as the breast skin does and, in large breast augmentations, one can see a relatively small nipple on a large breast mound. (which is not really natural) But I have yet to have a patient voice a concern or complaint about this issue.

For those women who are having an augmentation after childbirth due to loss of breast tissue, the reverse concern may occur…the nipple may be large and may get a little larger after the placement of breast implants. Many women who undergo breast augmentation after childbirth often have sagging as well and may be getting a lift at the same time. Too large a nipple can be easily reduced at the time of the combination breastlift/augmentation as there will be a scar around the nipple anyway.

Nipple reduction can be done at the same time as breast augmentation through a periareolar approach (donut cutout with resultant scar around the nipple) The key to success with that approach is based on the looseness of one’s breast tissue and the size of the implant being placed. If the breast skin ends up very taut or tight after a large implant, a nipple reduction should be deferred until later when the skin has had time to relax. Otherwise, you will end up with the same nipple width but with wide visible nipple scarring. If the implant is not too large and the skin is not too stretched, a concomitant nipple reduction can be successfully done at the same time.

Dr. Barry Eppley



Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana


Nipple Reduction and Areolar Gynecomastia Treatment in Men

Tuesday, July 7th, 2009

Gynecomastia (male breast enlargement) comes in many forms, from a large almost female looking breast to just a scant amount of excessive nipple or areolar projection. In my Indianapolis plastic surgery practice, I have seen more ‘minor’ cases of gynecomastia in the past few years. In these minor expressions of gynecomastia, there is a special subset in which the main aesthetic problem is that of excessive nipple projection.



Excessive nipple projection can occur in the teenage years as well as in the older male as well. The prevalence in the younger teenage and young male patient has a lot to do with cultural influences to which we are exposed today. The current appearance of the male models that are used in advertising show a chest that is both hairless but very smooth including a flat nipple. I call this the ‘Abercrombie Fitch’ look which helps drive a young males perception of attractiveness. As young male are often shirtless given their activities, this look can be very influential. Older male, conversely, are primarily bothered by the protrusion of the  nipple that can be seen through shirts.



In many cases, this nipple and areolar protrusion may or may not be part of an underlying mild gynecomastia. Some men merely have hyperactive nipples or more promiment nipples than others. In other cases, there may be a small or areolar gynecomastia that pushes the nipple forward by volume displacement.



Correction of these nipple and areolar protrusions are quite simple and uncomplicated. If the areolar is flat, but the nipple is undesiringly protrusive, a simple nipple reduction can be done. This is done by taking a wedge from the center of the nipple and closing it, making the nipple flat and permanently disrupting its ability to stick out any further. Some nipple sensation will be lost but this is usually irrelevant in a male. If the  areola is protrusive, then breast tissue must be taken out from underneath it. Through a semi-circular incision on the bottom part of the areola, the nipple and areola is lifted up and a wedge of tissue is removed. The amount of tissue removed should be sufficient enough that there is a slight indentation at the time of closure.



Both nipple reduction and areolar gynecomastia are simple outpatient procedures that have virtually no recovery and only a short limitation from strenuous activities after. Both heal with virtually no detectable scarring and consistent aesthetic improvement.



Dr. Barry Eppley

Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana





Nipple Reduction and Inverted Nipple Repairs

Saturday, April 25th, 2009

Nipples are as variable as the size and shape of breasts. No two nipples are ever exactly alike, usually not even on the same person. While much breast reshaping (breast augmentation, breast reduction, breast lift) goes on in plastic surgery, many men and women suffer from nipple deformities as well which also affects their self-esteem. Nipples can stick out too much, can be turned in, or the areola (the colored area surrounding the nipple) can be too large. Some of these nipple problems may affect certain breast functions such as feeling or lactation. The good news is that there are some very simple plastic surgery procedures that are quite effective at improving these problems.

For the sake of clarification, what most call the nipple is actually two different structures. The true nipple is the central projecting skin area that has both enhanced sensation and milk ducts for lactation. The flatter, almost always more pigmented, skin around the true nipple is called the areola. 

Nipple inversion  (shy nipple) affects about 2% of the population, more commonly in women than men. Some nipples can be turned in slightly or to a significant degree. Some people are born with nipple inversion, others occur later often after breastfeeding. In rare instances, a tumor may be pulling the nipple inward and this should be ruled out particularly if it occurs later in life and just on one breast. Correction involves a simple procedure done under local anesthesia. The nipple is released and brought out. The biggest problem with nipple inversion correction is relapse, the nipple losing projection and returning to an inward position. Nipple inversion surgery can also be done at the time of other breast surgery. I usually like to delay repair in the case of breast augmentation until later as the implant may help to push out some nipples, making correction unnecessary.

Enlarged nipples often create visible ‘headlights’ which can be a source of embarrassment for many women. This can also be an issue for some men. An overly projecting nipple can be easily reduced through a wedge excision or a ‘ring’ reduction approach. Sensation and the ability for milk production can be preserved with either technique. Done under local anesthesia, nipple reductions are very stable and are not associated with any significant relapse.

“Puffy” nipples can occur in women and are usually associated with the tubular breast deformity. In this nipple problem, the areola and the nipple are pushed outward due to an underlying herniation or protrusion of breast tissue. Correction of this problem is slightly more complex than isolated nipple surgery.  It is usually treated as part of tubular breast surgery which involves the use of a breast implant and areolar manipulation. This is treated by making an incision around the areola, removing some of the pigmented skin (if needed), and lifting the areola skin up and decreasing the projection (puffiness). This is a more extensive surgery and requires an operative room experience under anesthesia.

Large or wide areolas are extremely common in big breasts. Usually the size of the areola is related to the size of the breast, but not always. Large areolas are commonly reduced as part of breast reduction surgery. They can be reduced independent of a breast reduction through the periareolar approach. By removing a ring of the outer areola, the circular diameter of the areola is narrowed. Due the tightness of breast skin, there is a limit as to how much the areola can be reduced. This procedure results in a scar at the junction of the areola and skin which occasionally widens and requires secondary revisional surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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