Areola reduction

What is areola reduction?

Areola reduction is a cosmetic surgical procedure that reduces the size of the areola - the pigmented (coloured) skin surrounding the nipple. The goal is to create an areola size that appears more in harmony with your breast shape and size.

Is areola reduction surgery right for me?

Areolas naturally differ in size, shape and colour. If you feel self-conscious or unhappy about the size or shape of your areolas, areola reduction may be right for you.

There are a few reasons you might consider areola reduction surgery, including:

• Your areolas are larger than you’d like.
• Your areolas are asymmetrical.
• Your areolas have changed in size or shape during pregnancy, breastfeeding, ageing and weight changes.
• Surgeons often perform areola reduction alongside other procedures such as breast uplift, breast reduction, breast augmentation or gynaecomastia surgery.
• You want to tighten the skin around the areola for a firmer appearance.
• You have areolas that appear raised or “puffy”.

What happens during areola reduction surgery?

Preparing for areola reduction

During your appointment, your consultant (surgeon) will:

• Discuss your reasons for areola reduction, your goals, and what you hope to achieve from the surgery.
• Examine your breasts and assess the size, shape and position of your areolas.
• Review your medical history.
• Explain the different surgical techniques available for areola reduction and recommend the most appropriate method.
• Discuss scarring and what you can expect.
• Discuss the potential risks and complications.

They’ll also advise you about the following:

• What to expect during recovery and follow-up appointments.
• Whether you should continue or temporarily stop medications before and after your surgery.
• Stop smoking before your surgery, as smoking increases the risk of wound infections and delays healing.
• Fasting before your surgery (usually no food or drink for several hours before your surgery, if your surgery is performed under general or local anaesthesia).

Feel free to discuss any concerns or questions you may have about the surgery or your recovery with your consultant. They are here to help you feel informed and confident.

During the operation

Areola reduction typically takes 1 to 2 hours, depending on the surgical technique used.

When done as a standalone procedure, areola reduction surgery is performed under local anaesthesia with sedation. The area will be numbed, and you’ll remain awake but comfortable during the procedure.

General anaesthesia will be used:

• If you prefer to be asleep during surgery.
• If your surgeon performs an areola reduction alongside other procedures such as breast uplift, breast reduction, breast augmentation or gynaecomastia surgery.

Your consultant and healthcare team will discuss which type of anaesthesia is best for you.

Areola reduction techniques

Surgeons use several surgical techniques for areola reduction, depending on the size and shape of your areola and whether extra skin needs to be removed around the areola.

The “Doughnut” Technique (Periareolar Incision)
The “doughnut” technique is the most common method used to reduce the size of the areola.

1. Your surgeon will make two incisions (cuts) – one around the edge of where your new, smaller areola will be, and the second incision around the existing edge of your areola.
2. The surgeon removes the “ring” of skin between the two cuts.
3. The skin edge from the outside of the doughnut ring is brought inwards and sutured (stitched) to the skin edge of the new, smaller areola.

The Crescent Technique
This method is often used for people with minimal areola asymmetry or as part of a breast lift.

1. Your surgeon will make a curved, crescent-shaped incision (cut) at the top or bottom of the areola.
2. The surgeon removes the thin section of the skin.
3. Your surgeon will stitch together the two edges with stitches, pulling the areola upward or downward to change its size subtly.

The Lollipop Technique (Vertical Incision)
This method is often used as part of a breast lift or breast reduction.

1. Your surgeon will make an incision (cut) around the areola and then a vertical incision downwards from the bottom of the areola to the crease beneath the breast (inframammary fold). This will create a lollipop shape.
2. Your surgeon will then reduce the size of the areola using a similar method to the doughnut technique and reposition it before closing the incision with stitches.

The Anchor Technique (Inverted-T incision)
This technique is often combined with breast reduction or lift.

1. Your surgeon will make an incision (cut) around the areola and then a vertical incision downwards from the bottom of the areola to the crease beneath the breast (inframammary fold). A horizontal incision is also made along the inframammary fold.
2. Your surgeon will then reduce the size of the areola using a similar method to the doughnut technique and reposition it before closing the incision with stitches.

A light dressing or surgical tape is placed over the area to protect it while it heals.

Going home after your areola reduction

After your surgery, you can expect some pain, swelling and bruising. Your healthcare team will likely give you some pain medication to help manage the pain.

You should be able to go home on the same day as your surgery because surgeons usually perform areola reduction as a day case. Most people can return to their normal activities within a few days to a week. However, do not lift anything heavy or engage in strenuous activity for at least two weeks.

Before you leave the hospital, your consultant and healthcare team will give you instructions on how to recover at home. General aftercare advice may include:

• Wear a supportive bra (non-wired) day and night. This will help to reduce swelling and support healing.
• Keep the area dry and clean.
• Sleep on your back, with your upper body slightly elevated.
• Do not smoke, as this can delay healing.
• Avoid touching or scratching the area. Your areolas may itch during healing.
• Avoid sexual intercourse for at least 2 weeks.

What are the benefits of an areola reduction?

1. Improved appearance: Areola reduction can help the symmetry and shape of the areolas, making them appear more proportionate to the size of the breast.
2. Improved comfort: For some people, reducing the size of large or protruding areolas can help relieve physical discomfort during exercise or when wearing tight-fitting clothing and bras.
3. Increased self-esteem and confidence: Many people feel more comfortable and confident with the appearance of their breasts after areola reduction surgery.

How long will the results last?

The results of areola reduction are permanent. However, pregnancy, breastfeeding or significant weight changes may change the appearance of the areola.

What are the risks and complications of areola reduction?

Most people recover well after an areola reduction. However, like any surgical procedure, complications can occur. Your consultant and healthcare team will discuss all the risks and complications at your initial consultation.

General complications

• Pain.
• Infection.
• Bleeding: A small amount of bleeding is normal; however, if you experience heavy or continuous bleeding, please get in touch with your surgeon immediately.
• Reaction to anaesthesia: For example, nausea and vomiting.
• Blood clots (Deep vein Thrombosis DVT): A rare risk associated with any surgery.

Specific complications of areola reduction

• Loss of sensation: Temporary numbness or loss of sensation is common. Sensation will gradually return over time, but in some cases, your sensation may be lost permanently.
• Increased sensitivity: Some people may experience tingling, heightened sensitivity, or discomfort during healing.
• Asymmetry: Both areolas may heal differently, resulting in slight differences in size, shape or position.
• Changes the areola colour (pigmentation): The areola’s colour may lighten or darken, especially if the area doesn’t heal properly or sun protection is not used.
• Necrosis (tissue death): This is very rare but can happen if the blood supply to the area is disrupted. This is especially true for smokers or when surgeons combine areola reduction with other breast surgeries.
• Wound breakdown: The surgical incision (cut) may partially or fully open. This can be due to infection, poor healing, or tension on the stitches. If this happens, please get in touch with your surgeon immediately.
• Scar discolouration: Your scar may heal lighter or darker than the areola or breast skin.
• Uneven or puckered scars: The scar line may not be perfectly smooth or circular.
• Keloid and hypertrophic scarring: Large, raised scars may form, particularly in people prone to keloid and hyperthrophic scarring.
• Loss of ability to breastfeed: Areola reduction surgery can potentially damage milk ducts or nerves essential for breastfeeding. If a lot of tissue under the areola is removed to reduce puffiness, there’s a higher chance of affecting the parts needed for breastfeeding.

Pain after areola reduction surgery

You will receive a local anaesthesia during the areola reduction procedure so that you will feel no pain or discomfort. Following the procedure, you may experience some pain and discomfort as the site begins to heal. However, it usually gets better within two weeks.

Are there non-surgical alternatives to areola reduction?

No, there aren’t any non-surgical methods to reduce the size of the areola.

How much does an areola reduction cost?

Click here and select your local Nuffield Health hospital to find the guide price for areola reduction. Please note that the guide price stated is an approximate cost of treatment only. The hospital or your healthcare team will provide you with a fixed, all-inclusive price for the treatment following your initial consultation.