Percutaneous Correction of Protuberant Nipple-Areola Complex.

Abstract

The protuberant nipple-areola complex may exist alone or, more commonly, as a component of tuberous breast deformity. It can also appear following pregnancy.1 The deformity involves overprojection of the nipple-areola complex in an anteroposterior direction, yet the base diameter may be close to normal. Breast augmentation can reveal the existence of unidentified protuberant nipple-areola complex or can extenuate it in patients with tubular breasts.2 Neither a routine nor a dual-plane technique corrects it. An overlooked protuberant nipple-areola complex is one of the most frequent reasons for reintervention in the male population presenting with gynecomastia.3 That is why protuberant nipple-areola complex should be recognized preoperatively and treated properly. Underneath the nipple-areola complex, there are bundles of smooth muscle fibers in the connective tissue and along the length of the milk ducts that make the nipple-areola complex erect in response to various stimuli.4 That response can be intact (prompt reduction in areola diameter) or reduced. The purpose of this procedure is to make controlled burns of the muscle fibers, which will consequently induce scar repair and retract the muscle fibers, providing a low projection of the nipple-areola complex; however, the nipple-areola complex should still be present and not flattened. The procedure can be performed under local or general anesthesia. With a nipple pulled vertically using a hook or fingers, a 23-gauge, 40-mm-long needle is introduced through the areola parallel and between the muscle fibers (Fig. 1). We use a monopolar system (Force FX; Medtronic, Minneapolis, Minn.), with parameters selected on coagulation mode. The needle is connected to an electrosurgical pencil and power (25 W) is applied while the needle is slowly withdrawn for 2 to 4 seconds. This process is repeated at six to 10 different entry points around the nipple-areola complex. [See Video (online), which demonstrates controlled electrocoagulation of the relaxed erectile muscle.] The pinprick burns tend to heal, leaving no visible scars. Patients are advised to use an antibiotic cream. No antibiotics are prescribed; only pain killers as required. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video.","caption":"This video demonstrates controlled electrocoagulation of the relaxed erectile muscle.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_fco2g642"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Fig. 1.: Drawings showing (above) the direction of a needle during the controlled electrocoagulation of the relaxed erectile areolar muscle and (below) the muscle and nipple-areola complex retraction after the treatment.The generated temperature (60°C to 95°C) alters and denatures proteins and has the effect of coagulation and desiccation on relaxed erectile muscle in the nipple-areola complex.5 Scar tissue is formed, which strengthens and retracts the subcutaneous structures of the nipple-areola complex, thus resulting in nipple-areola complex retraction. From January of 2017 to December of 2019, we operated on 26 patients, five men with gynecomastia and 21 women with small breasts associated with this areola deformity. The mean patient age was 26.6 ± 4.3 years (range, 21 to 36 years). The deformity was present unilaterally in four cases and bilaterally in 22. The follow-up period ranged between 4 and 12 months (average, approximately 6 months). Some degree of retraction is observed immediately, but the result improves in the weeks following the procedure. We have not had problems with scars, infections, or recurrence. Temporary loss of sensation can occur, but it returns completely after 3 to 6 months after the procedure. The proposed procedure is safe and easy to perform, and applied in selective cases (both male and female), it can successfully correct protuberant nipple-areola complex without additional scars. It provides our patients with a long-term result in a single-stage procedure with the initial operation. DISCLOSURE Dr. Andjelkov is an owner of the company that distributes Motiva Implants in Serbia. The remaining authors have no financial interests to disclose. No funding was received for this article.