Some of the most common questions Southwest Plastic Surgery hears at the front desk are the ones patients are least comfortable asking out loud. Areola and nipple reduction is high on that list. Patients want to know if it is a real procedure, whether it hurts, what the scar looks like, and whether anyone will be able to tell.
Dr. Frank Agullo answers all of that in the consultation, and the first thing he does is separate two procedures that get lumped together.
“We should differentiate the two procedures. One is areola reduction, and the second one is nipple reduction.”
Who Comes In for This
Who asks for this, and what is most common?
Dr. Agullo: “I think the most common procedure is areola reduction, and I see it in both male and female patients. This can happen with increased weight, where the areola gets stretched. It can happen genetically, where you are just born with large areolas. It can happen after pregnancy, where the skin stretches out. Or after having implant placements, which also can stretch out the areolas.”
“Nipple reduction is more common in patients that genetically just have larger nipples. They may protrude, or they may be wider than usual. And it is most frequently seen in female patients.”
At the practice, the split is consistent.
“I would say that we perform areola reduction in about 50 percent of the patients interested in these procedures. Twenty-five percent will have a nipple reduction, and 25 percent will have both procedures.”
How Each Procedure Is Done
Technique, anesthesia, time, and scar?
Dr. Agullo: “An areola reduction can be done under local anesthesia. But many patients opt to do it under IV sedation, at least, or general anesthesia, for greater comfort. It involves resizing the areola to a smaller circle using a stencil, and cutting out the remaining hyperpigmented skin tissue. So in essence it’s two circles, which create the shape of a donut, and that’s why a circumareolar lift is called a donut lift, or donut reduction.”
“For the nipple reduction, there are many different techniques, and it depends on what we are targeting. If we just want to reduce length so the nipples protrude less, we may do a distal amputation. If there’s also enlarged girth, a wedge resection works better, since it addresses both protrusion and girth. Most of these procedures take under an hour.”
Under an hour. Local anesthesia is an option for either one, and IV sedation is the choice most patients make for comfort.
The Scar Patients Worry About
“In both of these cases, the scar result is very favorable. In an areola reduction, the scar lies right in the edge of the transition from the areola to the normal skin, so it hides very well in that transition zone. For a nipple reduction procedure, the scar heals almost imperceptible, within the hyperpigmented nipple skin.”
Recovery, Sensation, and Breastfeeding
Recovery and sensation?
Dr. Agullo: “Recovery for this surgery is rather fast. If it’s being done in a standalone fashion, most patients can return to normal, non-strenuous activity within two or three days. Exercise usually within two to three weeks.”
“Sensation is usually not affected by this procedure. There may be some transitional changes, where you may lose sensation, but it usually comes back within six months. A lot of patients experience hypersensitivity, which also returns to normal within six months. Most patients remain with normal sensation, and the chance of any change in sensation being permanent is less than 5 percent.”
“In terms of breastfeeding, areola reduction does not affect the ability to breastfeed in the future. Nipple reduction may, depending on the technique used. With the distal amputation, there are no changes. But if we do a wedge resection, we are excising some of the breast ducts, so it may affect breastfeeding in the future.”
Patients who plan to have children should say so at the consultation. It changes which nipple technique Dr. Agullo recommends.
Pairing It With Implants or a Lift
Many patients planning a breast augmentation ask whether the areola can be reduced in the same surgery. It can, and often is.
Combined with a lift or implants, and does it get bundled?
Dr. Agullo: “The technique for an areola reduction is the same as for an areola lift. The question is whether we’re lifting its position. So yes, an areola lift or an areola reduction is a very common procedure when we do a breast augmentation.”
“To be a candidate for this procedure, the nipple and areola should still be above the inframammary fold for best results. And the great advantage is that the scar is reduced compared to a full lift.”
“A nipple reduction can also be done in combination with a breast augmentation. Although I do not like to combine it with a breast lift. When we perform a breast lift, we are already cutting off circulation to the nipple and areola complex, so I would rather delay the nipple reduction to be done at a later time, so we don’t compromise the blood flow to the nipple.”
So a nipple reduction waits when a full breast lift is planned. Patients weighing a lift against implants can read the practice’s post on a breast lift with implants.
What It Costs at Southwest Plastic Surgery
“In terms of cost, when we perform a breast augmentation with a donut lift or circumareolar lift, the reduction of the areola size is included in the procedure. A nipple reduction would be a separate fee.”
As standalone procedures, as of this writing:
| Procedure | Starting price, local anesthesia | Starting price, IV sedation |
|---|---|---|
| Areola reduction | $3,500 | $4,500 |
| Nipple reduction | $2,500 | $3,500 |
| Both together | $6,000 | $7,500 |
“Doing both procedures at the same time does increase costs, because it will take longer in the operating room, so the operating room fee will increase. And if anesthesia is being used, that will increase as well.”
Current pricing lives on the practice’s fees page, and an exact quote can only be provided after a consultation. The full version of this post, with the comparison table and candidacy notes, is on agulloplasticsurgery.com.
Why Dr. Agullo
Dr. Agullo is certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at the Mayo Clinic, and serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. He has been a Castle Connolly Top Doctor for thirteen consecutive years. He publishes his prices.
Schedule a Consultation
Call Southwest Plastic Surgery at (915) 590-7900, text 1-866-814-0038, or book at swplasticsurgery.com. #StayBeautiful
Find Dr. Agullo at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
