Nipples, Areolas and More!

11 questions answered about the NAC!

By Dr. Killeen, published on March 3, 2022

nipple areolar complex

Patients frequently come to the office worried about their nipples. Often, it’s not even the nipple that concerns them, so let’s go over some anatomy.

What people are often talking about is the NAC, the nipple areolar complex. This is the nipple and areola together as a unit. There are also questions about the “bumps around the nipple” that are irregularly spaced around the areola. These are called Montgomery tubercules. Sometimes they may develop on the nipples themselves. Their primary objective is to produce oil, and they usually become larger during pregnancy or the menstrual cycle. So now that we have covered the basic anatomy, let’s take a look at some of the most common questions I receive about the NAC, both before and after a procedure.

Q: What are these bumps and can they be removed?

Women usually refer to the Montgomery tubercles when they say this. It is possible to remove them, but why would you? They are tiny, do not cause problems, and are completely normal. These patients are encouraged to save their money instead of undergoing a procedure to remove something normal that may leave a visible scar that is not usually more attractive than the gland itself. However, if there is an abnormal one, it can be removed if you find it bothersome.

Q: My nipple is too long, can you shorten it?

We can do that! Two techniques are available to shorten the nipple. The first involves removing some skin from the base and telescoping it in. The second involves amputating the tip, which actually heals just fine. You are more likely to be able to breastfeed with the second option.

Q: My nipple is too wide. Can you make the diameter smaller?

Yes, we can! We can do a wedge resection to reduce the diameter of your nipple if it’s too wide.

Q: My areola is too light or too dark, can you change this?

Simple answer: probably not. Changing the natural color of your areola is quite difficult and I do not recommend it. The color can sometimes be lightened by using skin lighteners or lasers, but it is difficult to darken it. It is unpredictable and expensive, in my opinion.

After breast surgery, the areola color may darken for 6-12 months. Typically, this occurs in people of color and improves without intervention. If your areola becomes very light from poor blood supply after surgery and no longer looks normal, you can go to a 3D tattoo expert. I recommend Holly at The Gilded Lily. Holly works with my breast cancer patients and she is amazing.

Q: My areola is too wide, can you make it smaller?

We can do that! An areolar reduction is also known as a circumareolar mastopexy. Though these procedures can reduce the size of the areola, you should keep in mind that they are notorious for stretching over time. They may even become bigger than they were at the beginning. Now you are left with a scar and a larger areola.

If your breast is droopy or ptotic, then converting the circumareolar mastopexy to a vertical (lollipop) mastopexy is more likely to properly preserve the areola size with the added benefit of making the breast appear more young and perky. If you are curious about how your areola stacks up, the markers we use in the OR are 38, 42, and 45 mm in diameter.

Q: I had breast surgery and my areola is indented at the bottom, can this be fixed?

Patients commonly complain about the dreaded inferior periaortic scar. As a result, this incision is rarely used for primary breast surgery anymore as it is associated with an increased risk of complications. There are a lot of women running around with this problem, and treating it can be quite frustrating.

When the tissue under the skin does not heal well, the skin sinks down and heals to the implant capsule. Some women may benefit from massage and cupping, while others may have a chronic condition. If non-invasive treatments don’t work, we can attempt surgical correction with scar revision, fat injections, or a combination of both.

Q: I had breast surgery and my areolas are different sizes, did two people sew me up?

The simple answer is no. Your areola was marked with the same exact marker. It is common for your body to heal differently on each side. This is usually caused by differences in how your dissolvable stitches dissolve and how your scar tissue matures. You will usually become more symmetrical with time.

Q: I had breast surgery and my nipple is not in the center of my areolar, did the surgeon do something wrong? Was he/she careless?

The answer to this question is also no. This is seen frequently with larger breast reductions. You have a natural contractile ability to your areolar tissue. This is what causes your nipple to become erect when aroused or cold. Sometimes after breast surgery the areolar tissue will not behave properly.

Depending on its condition, it either becomes hyperactive and stays contracted or it doesn’t contract at all. A single side of the areola doing this pulls the areola to one side. After your surgery, this usually improves over the course of 1-2 years.

Q: I had breast surgery and my NAC is very sensitive, what can I do?

Most often, this happens to women who undergo breast reductions. It can be quite annoying! It usually resolves within six to twelve months. Cold environments tend to aggravate it the most. Bundling up when it’s cold is the best option, as well as doing desensitization massage if it happens at random and isn’t related to the cold.

Q: My NAC’s are at different levels, can you fix this?

Although we can certainly do that, I remind my patients that chasing something that is normal often ends up in continued unhappiness. Remember perfection does not exist and the mild, normal asymmetries women have are perfect in my opinion!

Q: I lost my NAC from surgery (planned or unplanned result), is there anything you can do?

Definitely! Options include 3D tattoo only, nipple creation surgically with areola tattoo, or surgical areola/nipple creation. Your surgeon will tell you which option best suits you. In my opinion, I prefer 3D tattoos alone, as a surgically created nipple is always erect and can be seen under clothing. See above for my fav tattoo artist. They are not all created equally!

I hope this was helpful, feel free to ask me any additional questions you might have about the nipple areolar complex, or NAC!