This article gives an overview of the variety of nipple and areola options that are available to all top surgery patients–whether they are getting a chest reconstruction or breast reduction–and have been of particular interest to our non-binary, gender fluid and gender non-conforming patients. We discuss the difference between free nipple grafting and pedicle preservation for patients whose greatest priority is maintaining a heightened level of nipple sensation. Then, we go over the different options for altering the nipple-areola complex’s size, position and projection. We conclude by reviewing the possibility of having no nipples and how patients who opt to remove them can get hyper realistic nipples tattooed onto their chest by a trusted provider.
In plastic surgery terms, the areolas are the wide (usually circular) pigmented area that also contains the nipple. The nipple is the only part that projects outward from the chest and is usually somewhat cylinder shaped.
Top surgery patients seeking chest reconstruction or a breast reduction have the option of (1) undergoing a free nipple graft or (2) a pedicle preservation; both of these procedures can be used for chest reconstruction or breast reductions. A free nipple graft allows a surgeon to have greater control over the resizing and repositioning of the nipples and areolas. On the other hand, a pedicle preservation leaves a hope for heightened nipple sensation to be maintained by keeping the areola and nipple alive in its original form–as opposed to turning it into a skin graft. Concretely, this means that a surgeon must leave a certain amount of tissue behind to preserve the nipple’s original blood and nerve supply. As a result, the trade-off of a pedicle preservation is that complete chest flatness cannot be achieved. It is also important to note that with this procedure there is no 100% guarantee of nipple sensation conservation. A patient would have to wait up to two months after the procedure to know how much sensation will return to the nipples. The pedicle preservation is most commonly conducted as a part of an inverted-T or a buttonhole incision procedure.
Conversely, the advantage of a nipple graft is that it allows for the surgeon to take out all mammary tissue, leaving the patient with as much flatness as they desire. In the case of a breast reduction, a nipple graft allows the surgeon to have more precise control over the repositioning and resizing of the nipples; for instance, nipple grafting ensures that the nipple will be repositioned onto the most projecting point of the new, much smaller breasts. That said, even if you do not opt for free nipple grafts, you can still have your areolas resized (i.e., making your areola smaller).
For more information on ways that non-binary patients typically ask for their nipples to be resized and repositioned during top surgery, read the sections below. If you would like to read more about top surgery techniques that leave behind a degree of fullness to the chest or breasts, click here.
During a top surgery procedure, the areolas are usually resized to the diameter of 22 mm (about the size of a nickel) and are most commonly made to be circular. 22 mm is the average areola size of a cisgender male with minimal chest fat:
Smaller areolas (about 22 mm diameter) may be ideal for patients who desire a more conventionally masculine result to their top surgery procedure
Most often, if a non-binary individual wants to have a more androgynous appearing areola, they may choose a size that is slightly larger in diameter (usually 25 to 26 mm). This slightly larger areola option is about the size of an American quarter or a European One Euro coin.
Larger areolas (about 30 mm diameter) reflect a more conventionally “feminine” appearance and may appeal to non-binary or gender expansive patients who wish to customize the results of their top surgery procedure
Medium-sized areolas (about 25-26 mm diameter) example
Upward nipple location example
Inward nipple location example
No nipples, diagonal incision, example
No nipples, curved incision, example
If you’re interested in customizing a top surgery procedure so the end result feels or appears more affirming to you, please read this additional content on non-binary incision and chest contouring options.
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