Background: The nipple-areolar complex has both a significant functional and aesthetic contribution to the breast mound. Ideally the nipple-areolar complex should sit in the center of the breast mound and has a reasonable size that is not too big or too small. The concept of reasonable nipple-areolar size is a relative one and each person makes that judgment on their own. In general, diameters in the range of 38mm to 42mm are often cited as being a normal areolar size.
A reasonably-sized areola (the outer ring that makes up most of its diameter) will be highly influenced by the size of the breast mound onto which it sits. And most of the time there is a good correlation between the size of the two. But that is not always true and it is not rare to have a really large areola on a small breast mound. This disproportion between areolar size and breast mound is often called a mega-areolar deformity. Within these areolar deformities is a range of manifestations from just slightly too large to extremely so.
The size of the areola can be circumferentially reduced by a periareolar reduction technique. The larger outer ring of the areola is removed and downsized to the desired diameter. While a periareolar technique is more commonly associated with breast lifting through the removal of a ‘donut’ of skin, it works even better for reduction of the large areola. This is because the amount of areolar reduction needed is frequently less than the skin that would be removed in a breast lift. Less tissue removed translates to less tension on the wound closure, resulting in less risk of eventual scar widening
Case Study: This 22 year-old female had long been bothered by the size of her areolas. She felt they were too big and this was embarrassing for her. She was happy with the size of her breasts but felt the size of her areolas was too much for her smaller-sized breasts.
Under IV anesthesia and the injection of local anesthesia, her existing 52mm diameter areolas were reduced to 40mms by a circumferential excision of areola between the two markings. The areolas were closed in two layers with multiple deep dermal sutures with an overlying barbed suture subcuticular layer.
She had her incisions taped for a week and they were then removed. When seen one month later the areolar reduction was evident and she felt she had a bit of a breast lift as well. She felt that her entire breast mound had changed and she was very pleased.
While the short-term benefits of areolar reduction are obvious, the long-term question is how well will the scars do. Will they have any widening? And if so, how much? Final judgment of the periareolar scars will await a minimum of six months and possibly up to a year to see the final result after complete collagen maturation.
Case Highlights:
1) Large areolas (mega-areolar deformity) can be downsized through a periareolar reduction technique.
2) Periareolar reduction produces a very modest breast lifting effect.
3) Smaller areolas can make the breast mound look slightly bigger as the areolar-mound size ratio changes.
Dr. Barry Eppley
Indianapolis, Indiana