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.
Highlights:
- Protruding nipples in a male is often both a source of irritation and embarrassment.
- Male nipple reduction usually consists of complete nipple removal.
- 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