How is a Nipple Areolar Reduction Surgery Performed?

The surgery you're observing is a nipple areolar reduction (nipple lift surgery). This is for a young patient who has larger, widened areolar tissues, and wants a smaller areolar size (periareolar mastopexy). In order to do this, we remove the excess areolar skin and then elevate the breast skin in a circumferential manner around the areola so it's loosened. Then I use a suture called a GORE-TEX Suture that is extremely strong and versatile and does not stretch. I use this in a "cartwheel-style" pattern and cinch it in to reduce the size of the areola. The entire breast tissue will come in and you will get a really nice, small areolar diameter.

Nipple Areolar Reduction Before and After Photos

7 Questions from RealSelf, Answered

Board certified plastic surgeon Dr. Usha Rajagopal performs dozens of different procedures every week. Patients come to her with questions about every stage of treatment: from preparation to recovery.  This week we’ve gathered some commonly asked question taken from is the definitive community for cosmetic surgery, plastic surgeon review, and procedure referrals on the web. Through, Dr. Usha extends her expert knowledge to help everyday people better understand cosmetic surgery.

Today, Dr. Usha briefly answers 7 questions from the site, ranging from injectables to liposuction, to labiaplasty and more.

Question 1: Botox vs. Kybella in Jaw and Chin?

I had wanted to get Botox on my chin/ jaw area to make it appear more defined. I was wondering if this would remove any fat around that area. Would Kybella be a better option? I have very slight fat around (these areas), I just wanted it more defined. Thanks!

Dr. Usha: Both products work well for various indications in this area. Kybella is very effective in dramatically defining the jaw by removing bulk in the submental (double chin area) as well as jowl areas. Botox works well in narrowing the jawline in patients with square jaws. I have also found Botox very effective in redefining the jaw and neck area of older patients by treating the Platysmal bands of the neck in a procedure called "Nefertiti Lift."

Question 2: Labiaplasty Recovery: How Long Does It Take?

How long is the typical recovery period for Labiaplasty? What can I expect during the recovery period?

Dr. Usha:

  • You will generally need 3-4 days at home to recover.
  • Take Tylenol or the pain medication prescribed by your plastic surgeon to relieve your pain/discomfort. DO NOT take aspirin or ibuprofen because they can increase bruising and bleeding.
  • Shower the day after surgery.
  • Clean the incision site with hydrogen peroxide and put antibiotic cream/ointment on daily.
  • Your stitches should dissolve within 2-2 ½ weeks.
  • Swelling and tenderness should disappear within 6 weeks.
  • It will take between 6 months to a year before you will see the absolute final results.

Question 3: Should I Try to Lose Weight Before Liposuction?

I have scheduled my liposuction in about a month. I weigh approximately 142 lbs now, and am 5'4''. Should I maintain my current weight or try to lose a few pounds between now and then? I have been trying to lose weight and I'm not sure how much weight is even possible for me to lose in a month. Thanks!

Dr. Usha: If you plan to lose a significant amount of weight (30lbs or more) then it is a good idea to do this prior to surgery. If it is more like 5-10lbs, it will not make much of a difference to do this prior to or after liposuction.

Question 4: Can the O-Shot help with Urinary Incontinence?

Dr. Usha: The O-Shot procedure can treat both stress and urge urinary incontinence for 90% of women, while increasing lubrication in the vagina. Many women experience uncomfortable vaginal dryness and urinary incontinence caused by aging, pregnancy, menopause and other medical conditions.

Urinary incontinence can affect women of all ages, but the issue is most prevalent among older women. Another benefit of these injections are more youthful and smoother looking vaginal lips. Femilift is another non-surgical procedure that helps with urinary incontinence.

Question 5: How long will PRP for Hair Loss take to see the results?

Dr. Usha: You will start to notice results in about 4 to 8 months after your PRP hair regrowth procedure. This follows the normal hair growth cycle. With six to twelve months most patients will see remarkable improvement in volume and quality of their hair growth

Hair continues to thicken the next 12 to 15 months. And results can last for months or at time even years.

Question 6: Do You Lose 50 CC's with Behind the Muscle Silicone Implant Placement?

I am getting silicone breast implants on Friday and am really scared of going too big. I am currently a "B"; I want to be a "C". I have chosen 350cc in hopes they will look like the 300-325 implant I tried at my doctor's office.

Dr. Usha: Placing any breast implant below the muscle will cause the implant to loose a small amount of projection. Though the exact amount isn't quantifiable, your estimation is reasonable.

To choose a breast implant, place the implant in your bra. When the implant feels a little too big, you've probably found the right size.

Question 7: Is It Normal to Be Swollen and Hard After 2.5 Months Post Liposuction on Abdomen?

I had liposuction on abdomen 2.5 months ago. The swelling has gone down a little and it is not too tender now. I still have problems with numbness sensation in my abdomen. My abdomen also feels a little hard. Is this normal? When will most of the swelling go away? ...Is there something wrong?

Dr. Usha: It is completely normal to experience numbness and firmness in the area of the body where liposuction was performed.  When undergoing some sort of trauma to the tissue, the body naturally develops scar tissue which can feel firm and numb to the touch.  

Over time (generally 4-6 months), these areas will soften and sensation will return.  Massaging the scar tissue is one way to speed up the healing process.  I have my patients start doing daily massages about 1-2 weeks post op.  If self-massaging isn't enough, ultrasound massage treatments may be an option.

If you have additional questions about any of the procedures covered in this post, contact our office to schedule an appointment. Dr. Usha is a skilled specialist in vaginal rejuvenation procedures and has served the Bay Area for over 20 years. Book your free consultation and evaluation with her today.

Dr. Rajagopal is a RealSelf Top Doctor

The RealSelf Top Doctor (TOP) is a recognition awarded to less than 10% of doctors on RealSelf. This status is earned by achieving high patient satisfaction (as reported in RealSelf reviews), getting favorable feedback on their expert answers, and after investing significant time in Q&A and other doctor activity.

Realself Q&A: Will Pregnancy Ruin my Breast Implants?


Dr. Rajagopal's Answer on RealSelf:

When you become pregnant, your breasts go through changes due to the hormonal fluxes in your body—they enlarge, and sometimes change shape. In some rare cases, these changes are permanent, and pregnancy can actually leave you with fuller breasts. Generally, however, these changes are temporary, and last only until you have stopped breast-feeding your baby, after which point your breasts will go back to a smaller size. When this occurs—especially if your breasts changed size significantly during your pregnancy—you may develop stretch marks or lose breast tissue and experience sagging when your breasts return to their former size.

While such changes are obviously not very appealing, breast implants do not really have any bearing on the extent to which sagging or stretch marks will occur. Such side effects can manifest whether or not you have had breast surgery—across the board, plastic surgeons agree that implants do not tend to cause complications or exacerbate the aftereffects of pregnancy upon your breasts. Stretchmarks, for instance, are genetically linked, so implants will not increase your chances of getting them unless you are already prone to developing them. Furthermore, breast implants should not impair your ability to breast-feed: augmentation surgery can be done without affecting how your milk ducts or nipples function.

The effect that pregnancy has upon the breasts varies from woman to woman, making it difficult to predict exactly how your breasts will look afterward. A number of factors—including your age, your inherent skin quality, whether or not you’re a smoker, and the extent of your breast tissue enlargement—play a part in determining the end results of pregnancy in an individual; you won’t really know what’s going to happen until you are no longer lactating. Keep in mind, however, that what kind of implants you have makes a difference. Subpectoral implants—implants that are underneath the muscle in your chest—are supported and buffered by the muscles surrounding them, so the changes to your breast tissue do not affect them. Subglandular implants, however—implants placed above the muscle in the breasts—rely on the breast tissue itself for support, and so are more likely to fall after pregnancy. On a more positive note, if you are someone who has a particularly tight skin envelope before your pregnancy, the stretching that you’ll experience when your breast size increases may actually be beneficial—it can actually make your breasts look more natural afterward.

If you haven't gotten your breast implants yet and plan to have a baby soon, your doctor may advise you to wait until after your pregnancy to have surgery done, since it’s impossible to know exactly how your breasts will respond to pregnancy until you’re going through it. Also, if you experience extreme changes in breast size during pregnancy and while breast-feeding, you may want to consider getting some work done post-pregnancy if your breasts don’t return to a size and shape you’re happy with. If this occurs, consult with your doctor three to six months after you stop lactating to find out if this is a step you should take.

Dr. Rajagopal is a RealSelf Top Doctor

The RealSelf Top Doctor (TOP) is a recognition awarded to less than 10% of doctors on RealSelf. This status is earned by achieving high patient satisfaction (as reported in RealSelf reviews), getting favorable feedback on their expert answers, and after investing significant time in Q&A and other doctor activity.