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Large nipples which are out of proportion to the breast and areola can cause psychological and physical discomfort. Patients report embarrassment when wearing light clothing such as bathing suits or sheer dresses.  I have seen men with this condition as well, who are embarrassed by overly prominent nipples in sports shirts.

Many patients will tape their nipples or wear adhesive bandages to hide the protruding nipple.

The prominence of the nipple in relation to the breast or chest can also lead to physical problems such as chafing or ulceration with exercise, and I have had patients who have also reported significant irritation of the prominent nipple simply from a shower.

There is no universal agreement on what constitutes an overly prominent nipple, but generally anything more than 1cm wide by 1cm high is felt to be too large.  Most of my patients prefer 8mm by 8mm after surgery.

Many reported methods of nipple reduction will only reduce the height of the nipple papule, but not the width.  Over the last ten years I have treated many patients from our area, but also from Florida, Vermont, Connecticut, New Hampshire, and Maine who have traveled to see me for nipple papule reduction.  They have frequently been told that only the height of the nipple can be reduced, and are pleased to find out that there is a proven method that can reduce the diameter of the nipple papule as well.  The method that I have used is called the “modified top hat flap”, and was reported in our Plastic Surgery Journal in December of 2006.

The goals of nipple papule reduction are both functional and cosmetic. We would like our patients to maintain the ability to breastfeed and also preserve sensation: Therefore, I believe that it is important to preserve the central core of the nipple papule.

This procedure is easily performed in the office under local anesthesia, and I have had patients fly in and fly out the same day.  I have my patients protect the reduced nipple with a gauze pad and avoid strenuous physical activity for six weeks as the nipple is healing.  Healing has been uneventful in my patients, who have been uniformly pleased with the results.  I have not formally measured nipple sensation before and after the procedure, but the original article showed no sensory loss to formal monofilament testing in 11 nipples reduced in seven patients.  My patients have also reported normal sensation.  I am not aware of any of my patients who have had the occasion to breastfeed after their nipple reduction, but the lactiferous ducts are preserved in the central core of the nipple papule by this method, so we might expect this ability to be maintained.

In summary, I have been using the modified top hat flap procedure for ten years in both men and women who are troubled by prominent nipple papules.  It is easily accomplished in a one hour procedure under local anesthesia in the office setting. It is also an outpatient procedure.  Patients have been pleased and the postoperative recovery has been uneventful.