Nipple and Areola Reduction With Simultaneous Breast Augmentation - Techniques, Benefits, and Risks

What Are Breast Augmentation and Nipple and Areola Reduction Surgeries?

The nipple reduction is a surgical procedure to reduce the projection and circumference of the nipples. Areolar reduction is a simple surgical procedure used to reduce the circumference of one or both areolas. Breast augmentation is a surgical procedure to increase breast size by placing a breast implant beneath the breast tissue. The above procedures can be done simultaneously through the same incision, that is, nipple base incision, by providing better visualization and access, thereby allowing the placement of saline breast implants through the elasticity of the areolar skin.

The sub-muscular or sub-glandular implant pocket can be made through direct vision using proper instruments and techniques. It is a practical approach for nipple and areolar reduction with simultaneous breast augmentation does not affect the sensory supply of the nipple and also avoids additional scars by approaching through the same incision.

What Are the Indications for Breast Plastic Surgery?

• Postpartum patients with hypertrophic or elongated nipples.

• Mild cases of ptosis of the breast.

• Breast defects due to trauma, cancer, and congenital malformations.

• Aesthetic purposes include altering the breast size, shape, and feel.

• Post-lactation involution.

What Are the Contraindications for Breast Plastic Surgery?

• These procedures should be avoided in patients with underlying systemic diseases like advanced lung diseases, heart diseases, collagen vascular diseases, etc.

• Obese patients.

• Elderly patients are more than 65 years.

• Advanced breast cancer.

• Pregnancy and lactation mothers.

What Is the Technique for Nipple and Areola Reduction With Simultaneous Breast Augmentation?

Nipple reduction can be done by removing a partial or complete thickness of skin from the base of the nipple, and areolar reduction by marking the outer circular area from the bottom of the nipple to the outer margin to make it an equal distance and excising a donut-shaped area of skin within the outer circle marking to the base of the nipple.

This technique can improve scar camouflage and enhance the vision for breast augmentation. A purse-string closure helps keep the scar stable at the junction to the base of the nipple. Implant size can be chosen preoperatively during the consultation with the patient, and appropriate markings can be done based on the dimensions, mainly the base diameter. These markings are done in the patient with an upright position.

The commonly used implant used for this technique is a saline implant with an anterior valve. Local infiltration can be done using lidocaine with epinephrine in the base of the nipple and areolar tissue. A double loop is placed through the nipple with a 4-0 nylon traction suture. For nipple reduction, a nipple base incision is made.

Then a circumferential incision is made based on the desired reduction amount at the nipple base, mostly 5 to 6mm above the base, and then excise the full-thickness skin from the base of the nipple. A donut-shaped skin area is removed within the outer circle markings for areolar reduction. Using a scalpel blade or iris scissors undermines the areolar skin to the outer margin in the superficial plane. Skin hooks and needle-tip monopolar cautery can be used for retraction.

The elasticity of the areolar skin helps in better visualization and instrument access by allowing expansion of the nipple base incision. A right-angled lighted retractor having a width of 1cm and height of 6cm toothed blade can be introduced. An Aufricht lighted retractor can be used, but it has a different angle. Dissection then proceeds in the deeper subcutaneous plane towards the inframammary fold, and the nipple gets tucked in the superficial wound under the skin till it encounters the chest wall.

With a cautery, the desired implant pocket can be made in the sub-pectoral or sub-glandular plane. After thoroughly irrigating the implant pocket with antibiotic solution, place the implant by rolling the chosen implant tightly around the fill tube using a closed fill system. After confirming the position of the implant, close the incision in a purse string manner using a 4-0 polydioxanone suture.

If needed, it can also be further approximated with 6-0 fast-absorbing gut sutures. For dressings, wrap the nipple loosely with trimmed Xeroform or petrolatum-coated gauze to avoid excess pressure on the nipple. Dressing can be removed after 3 to 5 days; antibiotic ointment is advised.

What Are the Benefits of Nipple and Areola Reduction With Simultaneous Breast Augmentation?

• This procedure does not affect the sensory sensation of the breast or nipple.

• Avoid unnecessary scars by simultaneously doing these procedures in the same incision.

• Well-concealed scars.

• Improve the appearance of the breast and nipple.

What Risks Are Associated With Nipple and Areola Reduction With Simultaneous Breast Augmentation?

The early risks associated with this technique include:

• Excessive reduction of skin may lead to scar formation.

• Postoperative bleeding.

• Altered sensation.

• Wound dehiscence.

• Infection.

• Fluid accumulation.

Delayed risks after surgery include:

• Breast asymmetry.

• Wrinkling over the breast.

• Contracture of the capsule.

• Implant fracture.

• Altered cleavage plane between the breasts.

• Two saline breast implants may contact each other.

How Does Recovery Occur After Surgery?

• Most patients undergo uneventful healing after surgery and can do routine work within a few weeks.

• After a few hours of surgery, the patient may go home.

• During the healing period, the patient has to wear a sports bra to support the breast.

• Patients are advised not to lift heavy objects for the first few weeks.

• Avoid physical contact with the chest for three to four weeks.

• The patients are prescribed painkillers and antibiotics during recovery to relieve pain and reduce the infection.

• Exercises should be done based on the doctor’s advice.

• In the case of infection, signs like fever, redness, or soreness may appear at the surgical site; contact the doctor immediately.

Conclusion:

Nipple and areola reduction with simultaneous breast augmentation is a procedure used to improve the breast and nipple appearance by reducing the nipple size and form, reducing the width of the areola, and increasing the breast size by placing a saline breast implant beneath the breast. This technique improves patient satisfaction by avoiding unnecessary scars.