In this condition the nipple forms in two or three parts instead of just one. Under local anaesthetic, the two or three parts can be released and brought together as one. There is some scarring and the resultant nipple can feel quite rough until this settles. Postoperatively the nipple is protected from pressure for 3-4 weeks.
Fig1: a trilobed nipple before correction.
Fig.2: a bilobed nipple before correction.
Fig.3: same bilobed nipple after correction.
Small or inverted nipple
An inverted nipple is one that lies flat or below the surface of the skin. It is caused by tightness in the ducts or surrounding fibrous tissue. In some cases, erection still causes the nipple to protrude, in more severe cases it does not. This condition would normally happen during puberty. Where the nipple goes from being normal to retracting, it is essential to establish that this is not being caused by a breast cancer. A mammogram may be requested prior to surgery.
The treatment has two components. The first brings the nipple back to its normal position. A small incision between the nipple and areola allows access to the ducts which can be loosened. If this is not enough, some of the ducts can be cut. The second stage aims to keep the nipple out while the scar tissue forms. The Niplette suction device may prove useful. A nipple piercing may be unacceptable in some social circles, but can be extremely useful in keeping the nipple out. It can be discarded after 1 to 2 years.
After surgery the nipple must be protected from pressure for 3-4 weeks. Scarring is minimal.
Figure: An inverted nipple (a, b) can be brought out and held in place by a nipple piercing (c, d).
Oversized areola and nipple
This a purely cosmetic problem and opinions vary greatly as to what is the ideal size. There are variations between races and the only guide is what looks right for the individual. Approximately, for a Caucasian woman, an areola should be between 3.5 and 5.5cm.
Treatment can be performed under local anaesthetic. A doughnut of excess areola is removed. The resulting scar is very subtle as it is hidden along the edge of the areola. Healing takes approximately 2 weeks.
Overly developed Montgomery tubercle (areola bumps)
In this condition, the pigmented sebaceous glands around the nipple can become dark or prominent. They can be removed surgically, but it is better not to be overly aggressive in their treatment.
Montgomery tubercles (arrow)