Infographic comparing two techniques to correct Medially Positioned Nipples
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Written by revera-admin

When Nipples “Point In”: A Specialized Technique for Better Positioning

The Challenge of Nipple Position

Breast reduction surgery is not just about making the breast smaller; it is about reshaping it to look proportional and centering the nipple on the new mound.

Most standard breast reduction techniques (like the popular Superomedial Pedicle) assume the nipple is starting from a standard sagging position. But what happens when a patient’s nipples are naturally positioned medially—meaning they sit closer to the cleavage or “point inward”?

In these cases, using standard techniques can be mechanically difficult. Trying to move an inward-facing nipple into a central position can restrict the blood supply or create tension, limiting how perfect the final result can be.

The Solution: The Superolateral Pedicle (SLP)

A new study published in Plastic and Reconstructive Surgery (August 2025) highlights a specific surgical approach designed exactly for this anatomy: the Superolateral Pedicle (SLP).

How It Works

In breast reduction, the nipple is kept alive on a “pedicle”—a bridge of tissue that preserves blood vessels and nerves.

  • Standard Way (Superomedial): The tissue bridge is usually kept on the inner/top side.
  • The SLP Way: For patients with medial nipples, the surgeon keeps the tissue bridge on the outer/top side (Superolateral).

By anchoring the nipple from the outside, the surgeon can more easily swing and rotate the nipple into the perfect central position without fighting the breast’s natural tissue resistance.

Is It Safe? The Research Say Yes

Researchers from MedStar Georgetown University Hospital in Washington, DC, reviewed 164 breast reductions to compare the safety of this specialized SLP technique against the standard method.

The Findings:

  • Comparable Safety: The complication rates were nearly identical between the two groups (13.8% for SLP vs. 13.3% for standard), proving that this technique is just as safe as the traditional method.
  • Effective Reduction: The technique worked well for significant reductions, with an average tissue removal of over 700g.
  • No Re-operations: In this specific study group, zero patients in the SLP group required a return to the operating room for complications, compared to 5 cases in the standard group.

Why This Matters For You

Anatomy is unique. If you have noticed that your nipples sit closer to your breastbone or point inward, standard techniques might not offer you the best aesthetic result. This research confirms that your surgeon has a validated, safe “tool in the toolkit” to correct medially positioned nipples and achieve a beautiful, centered look.

Frequently Asked Questions (FAQ)

Q: How do I know if I have “medially positioned” nipples?

A: If your nipples seem to sit closer to your cleavage rather than the center of your breast mound, or if they point inward towards each other, you likely have medial positioning. Your surgeon will assess this during your consultation.

Q: Does this technique leave different scars?

A: generally, no. The Superolateral Pedicle refers to the internal tissue handling. The external scars usually follow the standard “Wise Pattern” (Anchor) or Vertical (Lollipop) shape, just like a regular breast reduction.

Q: Is the recovery harder with this technique?

A: According to the study, complications such as wound healing issues (dehiscence) or fluid collection (seroma) were comparable to the standard technique, suggesting the recovery process is very similar.

Q: Can I still breastfeed with this technique?

A: Like the standard Superomedial technique, the SLP preserves a bridge of tissue carrying blood and nerve supply to the nipple. While breastfeeding can never be guaranteed after reduction surgery, techniques that preserve the pedicle generally offer a better chance than those that do not.

Reference

Lava, Christian X. MS; Li, Karen R. BBA; Episalla, Nicole C. MD; Snee, Isabel A. BS; Bell, Alice C. BA; Fan, Kenneth L. MD; Jabbour, Samer F. MD. “Superolateral Pedicle Breast Reduction for Patients with Medially Positioned Nipple-Areola Complexes.” Plastic and Reconstructive Surgery 156(2):p 174e-182e, August 2025.

Breast Reduction, Nipple Correction
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Finally, a Solution for Nipple Reshaping Without the Visible Scars

The Hidden Insecurity

While breast augmentation and lifts are commonly discussed, many patients struggle silently with insecurities regarding the nipple-areola complex. Whether due to genetics, hormonal changes, or the aftermath of breastfeeding, common complaints include:

  • Large Areolae: An areola that feels disproportionately large for the breast.
  • Undefined Contours: A lack of crisp definition between the nipple and the surrounding skin.
  • Herniated Tissue: Often called “puffy nipples,” where glandular tissue pushes out, creating a dome-like appearance.

For years, patients have hesitated to fix these issues for one main reason: The fear of scarring.

Usual Scars

The Old Trade-Off: Shape vs. Scars

Historically, correcting the shape of the nipple or reducing the size of the areola came with a compromise. Previous techniques, such as the “petal pattern method,” were effective at contouring but often limited in how much they could reduce the areola size.

More importantly, these older methods frequently resulted in visible scars from the front. For a patient seeking aesthetic improvement, trading a shape issue for a visible scar was often a difficult choice.

The Innovation: The “Crown-Shape” Method

A breakthrough study published in Plastic and Reconstructive Surgery (June 2025) introduces a refined solution: the Crown-Shape Debulking Method.

Developed by Dr. Ju Young Go and Dr. Won Lee from leading clinics in Seoul and Anyang, South Korea, this technique is a “single-stage” procedure designed to reshape the nipple without leaving obvious marks.

How It Works

The “Crown-Shape” technique is an advanced evolution of previous methods. It involves:

  1. Debulking: Removing the herniated or excess glandular tissue that causes puffiness.
  2. Structuring: Using a specific “crown” pattern to tighten the skin and define the nipple.
  3. Hiding the Evidence: The key innovation is that it allows for significant reduction and reshaping “without visible scars in the frontal areolar area”.

Why This Is a Game-Changer

This new Korean technique addresses the limitations of the past. It offers greater control during surgery to ensure the new shape is aesthetically pleasing while minimizing the risk of the problem recurring (recurrence).

Key Benefits:

  • Scar-Free Frontal View: No distracting scar lines on the face of the areola.
  • Effective Reduction: Can handle larger reductions than previous methods.
  • Better Definition: Creates a distinct, attractive nipple contour.

Is This Right for You?

If you have been bothered by “puffy” nipples or large areolas but have avoided surgery because you didn’t want scars, the Crown-Shape Debulking method might be the answer. This technique allows for a natural look that stands up to close inspection.

Frequently Asked Questions (FAQ)

Q: What specific problems does this fix?

A: This technique is designed for patients with large areolae, undefined nipple contours, or herniation of glandular tissue (bulging/puffy nipples) around the areola.

Q: How is this different from the “Petal Pattern” method?

A: The “Petal Pattern” was a previous technique that was good for contouring but had limitations in how much it could reduce the areola size. Furthermore, the Petal Pattern often left visible scars when viewed from the front. The Crown-Shape method improves upon this by allowing for better reduction without the visible frontal scars.

Q: Is there really no scar?

A: All surgery involves incisions, but this technique is described as “scar-free” in the frontal areolar area. This means the incisions are strategically placed and hidden so that when looking at the breast directly, there are no obvious surgical markings.

Reference

Go, Ju Young MD, PhD; Lee, Won MD, PhD. “Scar-Free Nipple and Areola Contouring: A Crown-shape Debulking Method for Enhanced Aesthetic Outcomes.” Plastic and Reconstructive Surgery. June 20, 2025. Seoul and Anyang, Korea.

Areola Correction, Breast Reduction, Nipple Correction
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