First, let’s be clear on what the areola is. The areola is the colored portion around the nipple. The nipple is the thing in the center. We call the whole area the “nipple areolar complex” or NAC.
When you have large breasts or have breastfed, you may have changes in both. The areola though tends to be what we focus on. It is super rare for me to do a nipple reduction. But an areolar reduction? Do them all the time.
When we do a breast lift or breast reduction, we will adjust the size of your areola. The areola is just skin. It is a little different than other skin in that the pigmenation tends to be different, and there are elastic fibers which connect it to the smooth muscle in the nipple. That is why your nipple and areola contract when stimulated.
When we do surgery on the breast we use a nipple sizer. The two most common sizes used are 37mm and 42mm. (The average areola size is 38mm, but can go up to 100mm. We need it to be proportional to the nipple and breast size.) The nipple sizer is round with a hole in the center to center it on the nipple. We call it a cookie cutter, and it is the template we use when adjusting the size of the areola for the breast lift or breast reduction.
When you are healing, all sorts of things happen though. Sensation is off. When it returns, it does so in patches, so part of the areola contracts while the other side doesn’t. I liken this to a tug of war where one size is pulling and the other side doesn’t. What does this mean to you? While healing:
- One areola may look larger than the other
- The sensation may vary between the breasts and even within one breast
- The areola may not look round
- They look smooth and shiny, and generally as sensation returns will look more crinkled again
- Sensation can take a year or more to return
With surgery it is totally frustrating as time takes so long for some to heal. You need to let the dust settle and truly know it is done changing before fixing anything, as when the sensation returns the contraction in size and shape change occurs. Generally this makes the areola smaller again.
We use the same sizer for both sides. It is round in shape. But healing can be asymmetric. If it persists past a year, talk to your doctor. Usually a simple in office procedure can fix it. But you want to make sure the dust is truly settled before you do that. If your sensation is still changing, that is a sign things are still changing. The whole process on some can take more than a year.