Dr. Dirk Lazarus

Plastic, Reconstructive & Cosmetic Surgeon

MBChB (UCT), FCS (SA) Plast & Recon Surg

Nipple Areolar Issues

If you are uncertain as to which breast procedure(s) might be right for you then have a look at my page on breasts.

Inverted nipples may always be permanently inverted or occasionally so. For those that are only sometimes inverted, breast feeding, some forms of nipple piercing which keep the nipple out or a device called the niplette (made by Avent) may help. Nipples which are always inverted or those which do not respond to treatment with the niplette require surgery to correct.

Surgery is relatively minor. It is performed as day case surgery and can be done simply under local anaesthesia. Once anaesthetised, the nipple is incised and the fibrous bands causing the inversion are divided. To maintain the everted position, internal dissolving sutures are placed. Recovery is quick and you can resume normal activities shortly after surgery. Recurrence (return to an inverted nipple), can sometime occur.

Long/big nipples
Long or big nipples can be surgically reduced. Surgery is performed similarly to inverted nipple surgery except that excess nipple tissue is removed.

Before and after nipple reduction in a male

Before and after nipple reduction in a male

Areolar reduction
Large areolas may occur with large breasts in which case an areolar reduction will be done at the time of and as part of breast reduction. Similarly with other breast surgery, areolar reduction can be combined with the more major procedure.

Areolar reduction can also be done on as an isolated procedure. A donut of tissue can be excised to reduce areolar size. Bringing the larger outer circle to the smaller circle around the newly reduced areola can cause some puckering (a purse string effect), but this usually resolves after a few months. To prevent the areolas from widening out again in time, a permanent suture is left in around the areola. This permanent suture can sometimes be palpable (you can feel it) and if the suture ruptures the areola can stretch again. A peri-areola scar is the result of this procedure. Nevertheless areolar reduction, which is a relatively small procedure which can be done under local anaesthesia, is usually satisfying to the patient.



I and my boobs finally made it back to the UK after a 2 day visit to my Ouma, who lives near Jhb. Despite her failing eyesight, she was very impressed with my new figure!

I wish to extend my deepest gratitude and appreciation to you all, especially to Dr Lazarus, for the care, consideration and expertise, and for being instrumental in this most auspicious of transformations…thank you for more than I can say. I won’t hesitate to recommend you to all the small breasted women i meet!

May you all go from strength to strength, and may all your clients be as happy with their results as I am.

Testimonial, breasts