Why can't an areola reduction procedure be done by cutting and stitching around the nipple?

I always imagined areolas would be reduced from "the center" to hide scarring around the nipple, but I've noticed there is only one way to reduce the size of areolas which is by cutting around the areola leaving scars all around it. Why can't areolas be reduced by cutting around the skin of the nipple instead of cutting out the circumference of the enlarged areola? This might be pretty a dumb question, but I have always been quite curious of the reason behind never using a different approach.

Doctor Answers 13

Very thoughtful

This would be difficult because such a small diameter to pull skin in to the center would bunch up a lot, there would be so much tension on the small nipple itself that it would widen and flatten the nipple most likely over time, and sutures into the nipple base would most likely disrupt the ducts within the nipple.

Santa Barbara Plastic Surgeon
4.8 out of 5 stars 17 reviews

Areolar Reduction

That is a very interesting question.  The size of the areola is determined by the outer edge, and if the skin is removed around the nipple, the outer edge is not changed.  Also, there would be excessive bunching of skin around the nipple.  Best wishes.

Richard J. Restifo, MD
Orange Plastic Surgeon
4.9 out of 5 stars 106 reviews

Your thoughts are certainly innovative for reducing areolas

and could certainly be done if you are accepting of the potential scarring.  What I like about your approach is that the palpable ring of purse-string suture would not be that bothersome as it is with standard peri-areolar reductions.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Closing circles

A typical nipple may have a diameter of a half inch or 1 cm . The inner circumference is then a little more than 3 cm or 1 1/2 inches. Any concentric pigment  excision can be small. A larger diameter to start will allow an experienced surgeon to remove an inch in every direction. Look at our mommy makeover gallery on our site.

William C. Rigano, MD
Dayton Plastic Surgeon
4.4 out of 5 stars 10 reviews

Areola reduction

Actually a very interesting question.  We try to hide our scars as best as possible.  Typically the junction of areola skin to normal skin is the better choice for scar placement.  
Hope that helps!

Dr Morales
Houston, Tx

Rolando Morales Jr, MD
Houston Plastic Surgeon
5.0 out of 5 stars 38 reviews

Areola reduction

That could be done but two things are more likely to happen:
- the nipple ducts would be cut
- the scarring would be more visible because of pigmentation issues

If you are ok with that, then there is no reason not to have this performed.

All the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 166 reviews

Areola reduction

Very good question and observation and if the nipple area is large enough and the areola reasonably enlarged a purse string stitch could be used but it would be situationally dependent

Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 62 reviews

How Areolar Reduction Works

Areolar reduction is done to reduce the diameter and overall size of the areola.  The procedure requires pigmented areolar skin to be removed, and the resulting wound to be closed in a cosmetic fashion. 

If areolar pigmeted skin is removed from the junction of the nipple and areola, the resulting scar would likely not be pigmented like areolar skin.  It would likely show more in many patients.  Also, there would be more skin gathering or pleating than traditional techniques.

Areolar reduction is not for everyone, especially with the current limitations in technique.  Most patients are pleased with the results, and are happy with the tradeoffs.  However, if you do not need a lift, it may be best to really think about the procedure!

Stephen Bresnick, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 32 reviews

Why can't an areolar reduction procedure be done by cutting and stitching around the nipple?

This is an interesting question. Although it is possible to reduce the circumference to some degree by this approach amount of difference can be created is too small. Most patients who require reduction of the size of the areola would would not get enough reduction to make the procedure worthwhile.

John J. Edney, MD
Omaha Plastic Surgeon
4.8 out of 5 stars 117 reviews

Areolar reduction

Hello. It is possible to reduce a small amount of areolar tissue by the method you describe however.  it's not conventional or reasonable for the large amount of tissue that needs to be removed. Thanks for your interesting question. 

Dr. B

Carlos Burnett, MD, FACS
Westfield Plastic Surgeon
4.9 out of 5 stars 38 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.