Surgical treatment of nipple hypertrophy, nipple-areola symmetrization, and functional preservation – A systematic review

Published:August 22, 2022DOI:


      Nipple hypertrophy is a rare deformity that affects women's self-esteem. Several surgical techniques have been described for its treatment, but there is no gold standard technique, leaving the choice to the surgeon based on preference. A systematic review was performed using PRISMA guidelines on the surgical treatment of nipple hypertrophy over the period available. An illustrative case series was also included with 24 women, mean age 34.5 years, with nipple hypertrophy, treated with a functional preservation technique. This consisted of the removal of a circular segment of nipple tissue between the base and the tip, preserving its central structures, in conjunction with breast surgeries. The nipple-areola complex also underwent a procedure to achieve a 1:3 ratio. Postoperative follow-up was 12 months for the metric assessment, occurrence of complications, and tactile and pain sensitivities. A total of 1,064 articles were found, but only 19 were eligible. Most studies were classified with a low evidence level, homogeneous series, without the possibility of meta-analysis. Regarding the case series, the measurements of the vertical and horizontal axes varied, on average, 1.4 and 1.25 cm, respectively, in the preoperative period. No changes in the sensitivity were reported. No women had any of local or systemic complications. All of them were followed for at least 12 months, with preservation of the nipple-areola metrics. There is a need for better scientific evidence regarding the surgical treatment of nipple hypertrophy. The present surgical technique demonstrated the long-term preservation of nipple metrics without sensory or functional impairment.


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        • Jaimovich CA.
        Hypertrofic Nipple – contribuition on the study of its surgical repair. The “W” technique.
        Rev Bras Cir. 1982; 72: 123-130
        • Moliver C
        • Kargel J
        • Sullivan M.
        Treatment of nipple hypertrophy by a simplified reduction technique.
        Aesthetic Surg J. 2013; 33: 77-83
        • Marshall KA
        • Wolfort FG
        • Cochran TC.
        Surgical correction of nipple hypertrophy in male gynecomastia: case report.
        Plast Reconstr Surg. 1977; 60 (Accessed June 2, 2019): 277-279
        • Ferreira LM
        • Neto MS
        • Okamoto RH
        • Andrews JM.
        Surgical correction of nipple hypertrophy.
        Plast Reconstr Surg. 1995; 95: 753-754
        • Lai YL
        • Wu WC.
        Nipple reduction with a modified circumcision technique.
        Br J Plast Surg. 1996; 49 (Accessed June 2, 2019): 307-309
        • Fanous N
        • Tawile C
        • Fanous A.
        Nipple reduction - An adjunct to augmentation mammaplasty.
        Can J Plast Surg. 2009; 17 (Accessed June 2, 2019): 81-88
        • Dekkers OM
        • Cevallos M
        • Bührer J
        • et al.
        Comparison of noninferiority margins reported in protocols and publications showed incomplete and inconsistent reporting.
        J Clin Epidemiol. 2015; 68: 510-517
        • Howick J
        • Chalmers I
        • Glasziou P
        • et al.
        Oxford Centre for Evidence-Based Medicine - levels of evidence.
        Oxford Centre for Evidence Based Medicine, Oxford2020 (Published 2011. Accessed June 4)
        • McGuinness LA
        • Higgins JP.
        Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments.
        Res Synth Methods. 2020;
        • Sperli AE.
        Cosmetic reduction of the nipple with functional preservation.
        Br J Plast Surg. 1974; 27 (Accessed June 2, 2019): 42-43
        • Vecchione TR.
        The reduction of the hypertrophic nipple.
        Aesthetic Plast Surg. 1979; 3: 343-345
        • Lee EI
        • Withers EH.
        Geometric nipple reduction technique: An approach to management of nipple hypertrophy.
        J Plast Reconstr Aesthetic Surg. 2014; 67: 1301-1303
        • Yu Y
        • Wei L
        • Shen Y
        • Xiao W
        • Huang J
        • Xu J.
        Windmill flap nipple reduction: a new method of nipple plasty.
        Aesthetic Plast Surg. 2017; 41: 788-792
        • Economides JM
        • Pittman TA.
        The 4-flap Jester's hat technique for nipple reduction.
        Plast Reconstr Surg - Glob Open. 2017; 5
        • Sim HB
        • Sun SH.
        Nipple reduction with the chullo-hat technique.
        Aesthetic Surg J. 2015; 35: NP154-NP160
        • Ren M
        • Wang Y
        • Wang B.
        Nipple reduction using a three-dimensional Z-shaped incision technique.
        J Plast Reconstr Aesthetic Surg. 2013; 66: 770-775
        • Jin US
        • Lee HK.
        Nipple reduction using circumcision and wedge excision technique.
        Ann Plast Surg. 2013; 70: 154-157
        • Huang WC
        • Yu CM
        • Chang YY.
        Geometric incision design for reduction nippleplasty.
        Aesthetic Plast Surg. 2012; 36: 560-565
        • Tuncer S
        • Eryilmaz T
        • Atabay K.
        Correction of nipple hypertrophy: Nipple circumcision technique revisited.
        J Plast Reconstr Aesthetic Surg. 2010; 63: 1575-1576
        • Kim YS
        • Hwang K.
        Easy method for reduction of nipple height.
        Aesthetic Plast Surg. 2010; 34: 769-772
        • Kerr-Valentic MA
        • Agarwal JP.
        Reduction of the hypertrophic nipple following total skin sparing mastectomy.
        J Plast Reconstr Aesthetic Surg. 2009; 62: e652-e653
        • Basile F V
        • Chang YC.
        The triple-flap nipple-reduction technique.
        Ann Plast Surg. 2007; 59: 260-262
        • Cheng MH
        • Smartt JM
        • Rodriguez ED
        • Ulusal BG.
        Nipple reduction using the modified top hat flap.
        Plast Reconstr Surg. 2006; 118: 1517-1525
        • Van Wingerden JJ.
        Nummular nipple hypertrophy and repair as part of an aesthetic nipple- areola unit.
        Aesthetic Plast Surg. 1997; 21: 408-411
        • Regnault P.
        Nipple hypertrophy. A physiologic reduction by circumcision.
        Clin Plast Surg. 1975; 2 (Accessed June 2, 2019): 391-396