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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

Indianapolis, Indiana

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