Nipple Areolar Reduction

1. have large areola that they want making smaller
2. do not like the shape of their areola
3. have asymmetrical areola and want them symmetrising
4. have abnormal scarring as a result of previous breast surgery (e.g. Reduction or uplift)
5. want to improve self-esteem

When you are required to have a mammogram as part of the national breast cancer screening program, or for any other reason, please notify the radiographer that you have had surgery around the nipple-areolar complex.

There is no evidence that having surgery on and around your areola reduces the ability to detect breast cancer.

The operation can be carried out under a local Anaesthetic (you are awake) and takes around an hour to complete. You will be left with a scar around your areolar where the pigmented skin meets the native colour skin of your breast. You can go home the same day as the surgery.

You will be required to wear a non-underwired post-surgical support bra (Mr Davis advocates LipoElastic® garments) for a period of six weeks. You will be encouraged to shower twenty-four to forty-eight hours after surgery, however you are to dab your breasts dry, let them dry naturally, or to use your hairdryer on a cool setting to blow them dry – you are NOT to rub your breasts for one month after surgery.

After two weeks you will be asked to apply moisturiser over your scars on a daily basis for a period of three months.

You will come for a wound check one week after your surgery and return to see Mr Davis in clinic between four and six weeks after surgery, and again after three months. Further follow-ups will be arranged as necessary.

Bleeding & Haematoma
Bleeding can occur at any time in the first 10 days or so after the surgery so you should therefore avoid any trauma to your breast area and avoid strenuous exercise or anything that is causing your breasts to be moving vigorously in any direction. Where possible, arm movements should be limited in the first week.

Your breast will usually become swollen and tender with a bleed and may develop bruising – if this occurs you should return for review as you may require a return to the operating theatre to explore and stop any bleeding vessel(s)and remove any blood.

Seroma
This is a collection of clear/pale yellow fluid that essentially leaks and collects from the tissues as part of the normal reaction to surgery/injury. This nearly always resorbs over a period of weeks, but is occasionally large enough to warrant it being aspirated with a needle and syringe in clinic.

Infection
Whilst not common, should it occur your breasts may be swollen, red, warm/hot and tender – not to be confused with the inflammation of healing. You may also feel unwell in yourself. This is treated with a 5-to-7 day course of oral antibiotics. Very occasionally an infection can result in part(s) of the wound coming apart – this is managed by a regular change of dressings and showering, and will be allowed to heal by itself over the subsequent four-to-six weeks.

Swelling &/or bruising
Swelling will almost certainly occur naturally and can take months to fully settle down. Bruising can be treated, unless contraindicated, with the use of Arnica or other such products should you wish.

DVT/P.E.
Very occasionally a blood clot may form in one of the deep blood vessels in the leg (Deep Vein Thrombosis). Blood clots have the potential to break bits off that can travel up to the lungs resulting in a pulmonary embolus. As a way of reducing the risk you will be required to wear compression(TED) stockings on your legs from admission on the day of surgery until 2 weeks after surgery. You will also be encouraged to keep as mobile as is possible and to stay well hydrated.

Scars
Scars are by definition permanent, so will always be there. Initially scars can be red and with time should fade through pink to ultimately be pale and flat. Occasionally scars can become hypertrophic or keloid whereby they are raised, red, lumpy, itchy and unsightly or can stretch to become wider.

Altered nipple sensation – numb or over-sensitive
The nerves supplying the nipple areolar complex can be damaged during the surgery resulting in your nipple(s) feeling numb after surgery. This usually recovers with time, however permanent loss of or reduced sensation can happen. Ever so occasionally the nipple can become oversensitive.

Inability to breast feed
It is not uncommon to be unable to breast feed after a breast uplift as the milk ducts and/or nerve supply to them is interfered with when relocating the breast tissue.

Altered breast sensation/numbness
As per the nipple, nerve damage can occur to the nerves supplying the skin over the breast. This is usually temporary but can occasionally be permanent, resulting in numb skin.

Nipple loss – full or partial
Just as the nerves to the nipple can be damaged, so can the blood vessels that supply and keep the nipple areolar complex alive. Damage to these can result in some (partial) or all (full) of the nipple and areolar being lost.

Asymmetry
No two breasts are ever completely symmetrical – they are “sisters not twins”. Despite best efforts to make the breasts as symmetrical as is possible, minor asymmetries will remain after surgery. Very occasionally a notable asymmetry can occur that requires further surgery to adjust volume, shape or nipple position.

Fat necrosis &/or lumpiness
When the breast tissue is mobilised its blood supply can become compromised, as per the nipple, resulting in some fat and breast tissue dying off (necrosing). This presents itself as a firm lump or lumpiness within the breast, and will usually settle by itself over the subsequent months. Very occasionally the old liquid fat can discharge itself through a hole in the scar/wound, requiring regular dressings until it settle sand heals itself. Very occasionally the fat will calcify requiring further surgery to excise it.

Skin necrosis
Very rarely the blood supply to the skin of the breast can be compromised resulting in skin dying – this is most common at the T-junction where the vertical element of the scar meets the horizontal aspect of the scar in your breast crease. This is managed, should it occur, with dressings until healed. Very occasionally the scar requires revising.

Wound breakdown
Very occasionally some of the wound can come apart for a multitude of reasons. This is almost always small enough to manage conservatively with dressings, allowing nature time to heal the area. Should any scar that forms be unsightly or an issue then this can always be revised at a later date, often under a local anaesthetic such as those used by the Dentists if putting your teeth to sleep for a filling etc.

‘Dog ears’
These are little areas of skin and underlying fat/tissue that cause skin at the ends of your scars to sit a little proud. Often these settle with time and massage however occasionally they require removing under a local anaesthetic.

Further surgery in the future
This is likely to incur more costs