Skip to main content

Advertisement

SpringerLink
Log in

Management of Nipple-Areola Deformity

  • Original Article
  • Breast Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Herniated or pseudoherniated nipple-areolar complex (NAC), also called protuberant or “domed nipple,” is an entity that can be present both in males and females and represents a therapeutic challenge. It can be an isolated deformity, but in most cases is found within another breast deformity, such as tuberous breast or can appear following pregnancy. Its diagnosis and appropriate treatment become important when patients search for correctional breast surgery.

Objective

To review some common techniques for the treatment of tuberous breasts that address the nipple-areola problem as well, but also to present our experience with some newer and less invasive surgical techniques that could be useful for isolated treatment of herniated or pseudoherniated nipple.

Method

We performed a retrospective study that included all patients operated from December 2013 to December 2018. We reviewed existing techniques which in addition to our personal experience helped us to create an algorithm to assist surgeons in this matter.

Results

A total of 125 patients with herniated or pseudoherniated NAC were treated. There were 87 women and 38 men. The average age of the patients was 30, 8 ± 8.1 years (ranging from 20 to 63). We analyzed the results of four following techniques: periareolar mastopexy (52 patients), release of fibrous tissue in combination with lipofilling (19 patients), resection of herniated breast tissue (23 patients) or controlled electrocoagulation of relaxed erectile muscle (31 patients). The minimum follow-up for all cases was 4 months.

Conclusion

The achievement of a successful aesthetic result is possible in a single-stage procedure with initial surgery. It depends on careful individual preoperative evaluation of anatomical features and a surgical approach chosen accordingly.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Rees TD, Aston SJ (1976) The tuberous breast. Clin Plast Surg 3:339–347

    Article  CAS  Google Scholar 

  2. Grolleau JL, Lanfrey E, Lavigne B, Chavoin JP, Costagliola M (1999) Breast base anomalies: treatment strategy for tuberous breasts, minor deformities, and asymmetry. Plast Reconstr Surg 104:2040–2048

    Article  CAS  Google Scholar 

  3. Von Heimburg D, Exner K, Kruft S, Lemperle G (1996) The tuberous breast deformity: classification and treatment. Br J Plast Surg 49:339–345

    Article  Google Scholar 

  4. Gasperoni C, Salgarello M, Gargani G (1987) Tubular breast deformity: a new surgical approach. Eur J Plast Surg 9:141–145

    Article  Google Scholar 

  5. Osborne MP (1991) Breast development and anatomy. In: Harris JR, Hellman S, Henderson IC, Kinne DW (eds) Breast diseases, 2nd edn. Lippincott, Philadelphia, pp 1–13

    Google Scholar 

  6. Bass CB (1978) Herniated areolar complex. Ann Plast Surg 1(4):402–406

    Article  CAS  Google Scholar 

  7. Godwin Y (2018) Correction of tuberous nipple areolar complex deformity in gynecomastia: the deformity that can get forgotten. Ann Plast Surg 81(1):3–6

    Article  CAS  Google Scholar 

  8. Galych SP, Dabizha OY, Kostenko AA, Gomolyako IV, Samko KA, Borovyk DV (2016) Surgical treatment of tubular breast type II. Plast Reconstr Surg Glob Open 4(10):e1024

    Article  Google Scholar 

  9. Costagliola M, Atiyeh B, Rampillon F (2013) Tuberous breast: revised classification and a new hypothesis for its development. Aesthet Plast Surg 37(5):896–903

    Article  Google Scholar 

  10. Meara JG, Kolker A, Bartlett G, Theile R, Mutimer K, Holmes AD (2000) Tuberous breast deformity: principles and practice. Ann Plast Surg 45(6):607–611

    Article  CAS  Google Scholar 

  11. Alessandro I, Serena G, Marco I (2019) Correction of tuberous nipple areolar complex deformity in gynecomastia. Ann Plast Surg 83(3):367. https://doi.org/10.1097/SAP.0000000000001605

    Article  CAS  Google Scholar 

  12. Toranto IR (1981) Two-stage correction of tuberous breasts. Plast Reconstr Surg 67(5):642–646

    Article  CAS  Google Scholar 

  13. Persichetti P, Cagli B, Tenna S, Simone P, Marangi GF, Li VG (2005) Decision making in the treatment of tuberous and tubular breasts: volume adjustment as a crucial stage in the surgical strategy. Aesthet Plast Surg 29(6):482–488

    Article  Google Scholar 

  14. Zoccali G, Giuliani M (2012) Tuberous breast: clinical evaluation and surgical treatment. In: Agullo FJ (ed) Current concepts in plastic surgery. InTech. https://doi.org/10.5772/29225

    Chapter  Google Scholar 

  15. Tebbetts JB (2001) Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types. Plast Reconstr Surg 107(5):1255–1272

    Article  CAS  Google Scholar 

  16. Sforza M, Andjelkov K, Zaccheddu R, Husein R, Atkinson C (2016) A preliminary assessment of the predictability of fat grafting to correct silicone breast implant-related complications. Aesthet Surg J 36(8):886–894

    Article  Google Scholar 

  17. Gallegos ML, Casas LA (1998) A systematic, one-stage approach in the treatment of tuberous breast deformity. Aesthet Surg J 18(6):431–438

    Article  CAS  Google Scholar 

  18. Ribeiro L, Canzi W, Buss A Jr, Accorsi A Jr (1998) Tuberous breast: a new approach. Plast Reconstr Surg 101(1):42–50 (discussion 51-2)

    Article  CAS  Google Scholar 

  19. Kerfant N, Marchac A, Auclair E (2019) Fat grafting in composite breast augmentation with round implants: a new concept for breast reshaping. Aesthet Plast Surg 43(2):550–551

    Article  Google Scholar 

  20. Mandrekas AD, Zambacos GJ (2010) Aesthetic reconstruction of the tuberous breast deformity: a 10-year experience. Aesthet Surg J 30(5):680–692

    Article  Google Scholar 

  21. Bostwick J III (2000) Anatomy and physiology. Plastic and Reconstructive Breast Surgery, 2nd edn. Quality Medical Publishing, St. Louis, MO, pp 89–93

    Google Scholar 

  22. Khouri RK, Smit JM, Cardoso E, Pallua N, Lantieri L, Mathijssen I, Khouri RK Jr, Rigotti G (2013) Percutaneous aponeurotomy and lipofilling: a regenerative alternative to flap reconstruction? Plast Reconstr Surg 132(5):1280–1290

    Article  CAS  Google Scholar 

  23. Davison SP, Spear SL (2004) Simultaneous breast augmentation with periareolar mastopexy. Semin Plast Surg 18(3):189–201

    Article  Google Scholar 

  24. Mandrekas AD, Zambacos GJ, Anastasopoulos A, Hapsas D, Lambrinaki N, Ioannidou-Mouzaka L (2003) Aesthetic reconstruction of the tuberous breast deformity. Plast Reconstr Surg 112(4):1099–1108

    Article  Google Scholar 

  25. Rohrich RJ, Thornton JF, Jakubietz RG, Jakubietz MG, Gru¨nert G (2004) The limited scar mastopexy: current concepts and approaches to correct breast ptosis. Plast Reconstr Surg 114:1622–1630

    Article  Google Scholar 

  26. Regnault P (1976) Breast ptosis: definition and treatment. Clin Plast Surg 3(2):193–203

    Article  CAS  Google Scholar 

  27. Abbate OA, Fan KL, Nahabedian MY (2017) Central mound mastopexy for the correction of tuberous/tubular breast deformity. Plast Reconstr Surg Glob Open 5(11):e1545

    Article  Google Scholar 

  28. Teimourian B, Adham MN (1983) Surgical correction of the tuberous breast. Ann Plast Surg 10(3):190–193

    Article  CAS  Google Scholar 

  29. Weiner DL, Aiache AE, Silver L, Tittiranonda T (1973) A single dermal pedicle for nipple transposition in subcutaneous mastectomy, reduction mammaplasty, or mastopexy. Plast Reconstr Surg 51(2):115–120

    Article  CAS  Google Scholar 

  30. Ribeiro L (1975) A new technique for reduction mammaplasty. Plast Reconstr Surg 55(3):330–334

    Article  CAS  Google Scholar 

  31. Hamilton S, Gault D (2003) The tuberous male breast. Br J Plast Surg 56:295–300

    Article  CAS  Google Scholar 

  32. Andjelkov K, Music N, Mosahebi A, Colic M (2020) Percutaneous correction of protuberant nipple areola complex. Plast Reconstr Surg. https://doi.org/10.1097/PRS.0000000000007489 (Epub ahead of print)

    Article  Google Scholar 

  33. Munro MG (2012) Fundamentals of electrosurgery part i: principles of radiofrequency energy for surgery. In: Feldman LS et al (eds) The SAGES manual on the fundamental use of surgical energy (FUSE). Springer Science+Business Media, LLC, New York, pp 15–59

    Chapter  Google Scholar 

Download references

Acknowledgements

We would like to thank Dr Ramon Llull for his inputs in structuring the manuscript and the algorithm.

Funding

No funding was received for this article.

Author information

Authors and Affiliations

  1. The Faculty of Medicine, University of Belgrade and Belprime Clinic, 16 Brane Crncevica, 11000, Belgrade, Serbia

    Katarina Andjelkov

  2. Colic Hospital, Belgrade, Serbia

    Nikola Music & Milan Colic

  3. Royal Free Hospital and University College London, London, UK

    Afshin Mosahebi

Authors
  1. Katarina Andjelkov
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikola Music
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Afshin Mosahebi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Milan Colic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katarina Andjelkov.

Ethics declarations

Conflict of interest

Dr Katarina Andjelkov is the owner of the company that distributes Motiva implants in Serbia. Other co-authors have nothing to disclose.

Ethical Approval

This study was approved by the Ethics Committee of the Hospital Colic, Belgrade. The procedure was conducted in accordance with the Declaration of Helsinki.

Informed Consent

All participants provided written informed consent prior to inclusion in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file 1 (MP4 10155 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Andjelkov, K., Music, N., Mosahebi, A. et al. Management of Nipple-Areola Deformity. Aesth Plast Surg 45, 1407–1415 (2021). https://doi.org/10.1007/s00266-021-02308-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-021-02308-1

Keywords

Search

Navigation