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