A woman in her early 30’s who is bothered by prominence of her nipples in and out of clothing. She does not have irritation. She also has some mild retraction of the nipple ducts. Her nipple papules are wide and the breast is cone shaped, making it difficult to perform a top hat flap. The top hat flap would not reduce the nipple papule diameter enough, and because the nipple is sitting on top of the cone of her breast, would not reduce the prominence enough. She elected for a nipple amputation technique and is shown 6 weeks after surgery. She is thrilled to have a correction of the prominence. The continued mild nipple retraction which is due to shortening of the nipple ducts is not bothering her at this time.
A man in his later 50’s who has been bothered for years by prominence of his nipples which is visible through his clothing.
He is shown before and again, 6 weeks after bilateral nipple papule reduction with an amputation technique leaving a 3-4 mm base. He is thrilled with his improvement and tells me he wishes he had done this years ago.
An Asian woman in her mid 30’s with bilateral nipple hypertrophy is shown before and again, 2 ½ years after top hat flap reduction of the right and 6 weeks after a second top hat flap reduction on the left. Her initial correction was good but her left nipple papule had increased in size some following her initial procedure and the second reduction was performed.
A man in his early 30’s who had gynecomastia surgery 10 years somewhere else before but is still bothered by prominence of his nipple papules in clothing. He works in the travel industry and is lucky to be able to spend a lot of time at the beach and in summer clothes. His left nipple bothers him more than the right nipple. The left nipple papule is 6 mm in diameter and 7 mm high. His right nipple papule is 5 mm in diameter and 5 mm high. After discussions we decided to proceed with bilateral nipple papule reduction utilizing the nipple amputation technique under local anesthesia in the office. He is shown before and again, 6 weeks after correction.
Discussion: He appears that he may still have mild gynecomastia but this is not present with the “hands on the head” view and may be due to mild skin laxity but not additional tissue thickness which means that further surgery of the chest would not be helpful. His nipples do appear prominent. “Normal” measurements for the nipple papule have not been reported but in a female are generally considered to be 8 by 8 mm. My experience in males is that they prefer a flatter nipple to prevent prominence in clothing. Our patient is thrilled with the normal appearance of his nipples and no longer has prominence of the nipples visible in a thin shirt.
A woman in her mid 30’s who is bothered by prominence of her nipples. She wanted them to be smaller and less prominent in clothing but still natural in appearance. There is no standard measurement for a hypertrophic nipple but a “normal” nipple is sometimes suggested to be 1 cm wide by 1 cm in projection and in a women I typically aim for a correction to reduce the nipple to 8 mm wide by 8 mm high, as we have done here. Our patient is shown before and again, 6 weeks after a “top hat flap” nipple papule reduction performed under local anesthesia in the office. Her nipple sensation remains intact and she is thrilled with the correction.
An athletic man in his early 70’s who had been troubled for years by prominent nipples that showed through his shirts. He did not want an extremely flat nipple papule as is the request of some men, but wanted to have normal prominence of the nipple papule with his shirt off, but correction of the excessive prominence. He is shown before and again, 3 months after nipple papule reduction in the office.
A woman in her early 30’s who is bothered by prominent nipples and hides them with a padded bra. She notes that her nipples are sore when she ovulates but does not have irritation of the nipples in the shower or with sports. She is shown before and again, immediately after a Top Hat flap nipple papule reduction and then 6 weeks after.
A medical student in his mid 20’s who has mild breast development on his left side in the 7th to 8th grade along with prominence of the nipple. He is mainly bothered by the prominence of the nipple in some clothing and with his shirt off. Because the breast development was mild and the issue that bothered him the most was prominence of the nipple, we decided to address this first. He is shown before and again, 6 weeks after nipple papule reduction in the office under local anesthesia. He is thrilled with his early result and is no longer bothered by the appearance of his chest with or without a shirt.
A man in his late 50’s who is bothered by enlargement of his nipples. He had nipple piercings when he was younger and the nipple papules grew. He had had the piercings out for years but was embarrassed by the prominence of his nipple papules in clothing, especially fitted shirts. He was also bothered by their appearance with his shirt off. He described his nipple papules as looking like “gumdrops”.
He wished to have a normal appearing nipple papule but not overly reduced either. His nipple is prominent in width and in height, and needs to be reduced in both dimensions. A nipple amputation technique, which removes the top of the nipple, would only reduce the height.
He is shown before and again, 6 weeks after bilateral nipple papule reduction using the Top Hat Flap technique under local anesthesia in the office. He is thrilled with his result and being able to wear fitted shirts again.