Surgical treatment of nipple hypertrophy, nipple-areola symmetrization, and functional preservation – A systematic review

Nipple hypertrophy is a rare deformity that affects women's self-esteem. Several surgical techniques have been described for its treatment, but there is no gold standard technique, leaving the choice to the surgeon based on preference. A systematic review was performed using PRISMA guidelines on the surgical treatment of nipple hypertrophy over the period available. An illustrative case series was also included with 24 women, mean age 34.5 years, with nipple hypertrophy, treated with a functional preservation technique. This consisted of the removal of a circular segment of nipple tissue between the base and the tip, preserving its central structures, in conjunction with breast surgeries. The nipple-areola complex also underwent a procedure to achieve a 1:3 ratio. Postoperative follow-up was 12 months for the metric assessment, occurrence of complications, and tactile and pain sensitivities. A total of 1,064 articles were found, but only 19 were eligible. Most studies were classified with a low evidence level, homogeneous series, without the possibility of meta-analysis. Regarding the case series, the measurements of the vertical and horizontal axes varied, on average, 1.4 and 1.25 cm, respectively, in the preoperative period. No changes in the sensitivity were reported. No women had any of local or systemic complications. All of them were followed for at least 12 months, with preservation of the nipple-areola metrics. There is a need for better scientific evidence regarding the surgical treatment of nipple hypertrophy. The present surgical technique demonstrated the long-term preservation of nipple metrics without sensory or functional impairment.