For The Love Of Areolas

For The Love Of Areolas

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Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases.

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What You Need to Know About Breast Reconstruction After Mastectomy

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What Is Paget's Disease of the Nipple?

Understanding Breast Cancer Surgery Options

What is the Connection Between Areolas and Breast Cancer?

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An Overview of Subareolar Nipple Abscess

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Verywell Health's content is for informational and educational purposes only. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Ⓒ 2022 Dotdash Media, Inc. — All rights reserved

Verywell Health is part of the Dotdash Meredith publishing family.

Lauren Schlanger, MD, is a board-certified primary care physician with a focus on women's and transgender health.

The areola is the darker-pigmented disc of skin that surrounds the nipple. It is as individual in appearance—including size and color—as is hair color or body type. The appearance of the areola is different in different people, and it also changes over time. Both pigmentation and the size of the areola vary across the life course.

The skin of the breast has three distinct sections: the nipple, areola, and general skin. The nipple contains several milk ducts.

It is surrounded by the areola, otherwise known as the areola mammae. This is a circular, darkly pigmented area somewhere between the nipple and the surrounding skin in its structural complexity. The average diameter of the areola is 15-16 millimeters (mm), although they get larger during pregnancy and lactation.

The pigment in the nipple is made by melanocytes . The color can change over time, depending on stimulation. For example, the areola pigment usually gets darker during pregnancy and lactation and then stays darker afterward. 1

The average size of the areola varies substantially across individuals and lifespan. In women, the size of the areola increases substantially during puberty. 2 It may then increase again should a woman get pregnant and lactate. 3 Areola size tends to increase with breast size, and larger areola may be somewhat less sensitive to touch. 4

Studies of areola size tend to be done on relatively small populations of specific ethnic backgrounds and ages:

In general, men have smaller areolae than women. (This is why the nipple-areola complex is altered during top surgery ). However, there is a substantial variation in the size of the nipple-areola complex in men as well. One study done in hospitalized British men found a range of sizes from 9-44 mm with an average of 27 mm. 10

Small areolae are normal. Medium areolae are normal. Large areolae are normal. Areola size is as individual as height or the difference in width between a person’s shoulders and hips. The size of your areola is not something to worry about, and a change in the size of your areola over time doesn’t mean anything is wrong.

There are several distinct structures found in the areola.

Montgomery’s tubercles are small oil-producing (sebaceous) glands that look like small bumps in the areola. These bumps get larger during pregnancy and lactation and may appear to be small pimples. They then generally get smaller again after lactation is finished.

The function of Montgomery’s tubercles is to secrete an oily substance to lubricate and protect the nipples. They also secrete a small amount of milk during lactation.

The dermis of the areola is the underlying structure that supports the visible portion. It contains nerves, smooth muscle, and different types of connective tissue. There is also a large number of blood vessels.

Stimulation of the areola can contribute to the erection of both the nipple and areola. This erectile and contracting function helps to empty the nipples of milk during lactation. 1 The erectile function of the areola can also make it easier for a suckling infant. 11

Although the nipples and areolae of men and women vary significantly in size, their structures and functional ability are basically the same. With the correct hormonal stimulation, people of any gender or sex are capable of breastfeeding.
A case report published in 2018 described a transgender woman who breastfed her child and was the sole source of nutrition for six weeks. 12 Transgender men can also breastfeed. 13
Cisgender men may also experience milk production. It can be induced with medication or occur with certain hormonal conditions or other types of stimulation. 14 This is referred to as galactorrhea. 15

The areola changes significantly in size over the lifespan. The first noticeable change takes place around the time of puberty. As the breasts begin to grow, the pigmented area of the areola also gets larger. As breast growth continues, the nipple and areola eventually form a raised area, not just one that is more darkly colored.

During pregnancy and lactation, the areola starts to grow again and also becomes more darkly colored. This corresponds to a time when the size of the breast is also increasing.

However, after lactation is finished, breast size goes down while areola size and color tend to stay the same. 1 The areola may get slightly smaller and lighter, but it is unlikely to revert to pre-pregnancy size and color, and may not change back at all.

There is little to no research on changes to the areola during menopause.

Only a few types of changes to the areola require medical intervention or evaluation by a doctor. Simple changes in size or color, particularly during periods of hormonal changes, are not something to be worried about.

This is also true if one areola is larger than the other—many women have a size difference between their areolae. In general, it is only necessary to see a doctor for changes to your areola if they involve a rash or other types of discomfort. Conditions that can affect the areola include:

Nipple eczema is a skin condition that can occur in people with atopic dermatitis . It appears as thick or scaly skin on the nipples and sometimes as raised, uncomfortable bumps. In some cases, people can develop eczema on their nipples when they have no other signs of atopic dermatitis.

This is more likely to occur during breastfeeding. Nipple eczema usually appears on both breasts at the same time.

Paget’s disease of the nipple is a very rare type of breast cancer. It may first appear as a single bump or lesion that grows and spreads over time. This lesion may cause itching or the development of ulcers.

Lumps and bumps that appear only on one areola, increase in size over time, and expand over the areola should be evaluated by biopsy. 16 Paget’s disease of the nipple may need to be treated with lumpectomy.

Erosive adenomatosis is a usually benign, ulcerative lesion of the nipple. 17 It is very uncommon and only rarely associated with cancer. Other benign tumors of the nipple-areolar complex can also occur. 16 These may need to be treated surgically.

Abscesses and infection can occur both beneath the areola ( subareolar ) and around it (periareolar). These are more common in people who are pregnant or lactating. Infections during pregnancy and lactation tend to occur in younger women, whereas those that occur outside the context of pregnancy tend to take place closer to menopause. 18

In general, these infections are identified due to pain or discomfort in an area of the breast. There may also be a swollen area beneath the areola or a lump. Any abscesses may need to be drained as well as treated with antibiotics.

There is no medical reason why someone would need to change the size or color of their areolae. However, people may choose to alter the appearance of the areola to address cosmetic concerns.

Individuals who have undergone breast reconstruction following mastectomy may also need nipple and areolar reconstruction 19 and/or nipple tattooing . 20 In the context of breast reconstruction after cancer, nipple reconstruction is considered to be medically necessary and not cosmetic. 21 It should therefore be covered by insurance.

Surgery can be used to adjust the size of the nipples and areolae. This surgery is most often done in the context of a breast reduction, but it can also be done on its own. 22

Surgery used to alter the size and shape of the areola can permanently reduce sensitivity or eliminate feeling in the nipple and may affect sexual sensation and pleasure. 23 It may also impact a person’s ability to breastfeed. 24

Research has found that both nipple tattooing 25 and nipple reconstruction can improve satisfaction with the reconstructed breast when nipple-sparing techniques are not used in the original surgery. 26
Nipple-sparing mastectomy is not always an appropriate type of breast cancer surgery, depending on the type and extent of the cancer.

Although there are a number of skin-lightening creams marketed for use on the nipples, there is very little research about their safety and efficacy. What little research exists suggests that, at least in some cases, the use of these creams can result in increased pigmentation rather than lightening. 27

Formulations that are more likely to affect pigmentation are also more likely to cause damage to the skin, and these medications should not be used except under the guidance of a dermatologist.

While it is possible to undergo surgical and medical treatments to alter the size and color of the areolae, people considering these options should think long and hard about whether they are a good idea.

These procedures can make the nipples less sensitive and affect the enjoyment of touch. They can make it more difficult to breastfeed. That’s a lot to risk for purely aesthetic concerns, even though it may make sense for some people.

Before undergoing any nipple and areola altering surgery or medical treatment, people should think about why they are considering it. What messages are they getting about what their bodies should look like?

Do those messages reflect racist, ageist, or sizeist beliefs about the ideal areolar size or color? Are they subscribing to patriarchal beauty beliefs, trying to make a sex partner happy, or do they truly feel they would like their bodies more with a change?

People have a lot of different beliefs about cosmetic surgery. It can have a positive effect on people’s lives, but it can also result in discomfort and changes in function without any noticeable improvement in day-to-day life.

Breast reduction can noticeably improve pain and quality of life as well as people’s satisfaction with their appearance. 28 However, procedures to address areola size and color changes only have the potential to improve an individual’s satisfaction with their appearance.

That may be harder to reconcile, with the possibility of changes in sensation and other concerns about long-term function.

The nipple-areola complex is an important part of the breast. This structure is found in people of all ages and sexes, and there is much variability in its appearance. While areola size generally scales with breast size, some people have bigger nipples, and some have smaller nipples. That’s true and normal for both men and women.

People who undergo pregnancy and lactation usually see an increase in the size of their nipples and areolae. They may also get darker and more prominent. This isn’t a health problem and shouldn’t cause concern or alarm.

The color and shape of the nipples change over the course of a person’s lifespan, and it’s a natural consequence of hormonal changes and aging. No matter the size, the color, or the person’s sex, the nipples and areolae have the same range of potential function.

If they’re larger or smaller than average, that’s not a reason to seek a change. If they are browner rather than pink, or darker rather than light, that doesn’t mean anything is wrong.

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Lawrence RA, Lawrence RM. Anatomy of the Breast. In Breastfeeding: A Guide for the Medical Profession (Eighth ed., pp. 34-55).
Longo B, Campanale A, Santanelli di Pompeo F. Nipple-areola complex cutaneous sensitivity: a systematic approach to classification and breast volume . J Plast Reconstr Aesthet Surg . 2014;67(12):1630-1636. doi:10.1016/j.bjps.2014.08.043
Aygün AD, Akarsu S, Güvenç H, Kocabay K. Nipple and areola diameter in Turkish pubertal girls . J Adolesc Health . 1998;23(1):55-57. doi:10.1016/s1054-139x(97)00272-3
Avşar DK, Aygit AC, Benlier E, Top H, Taşkinalp O. Anthropometric breast measurement: a study of 385 Turkish female students . Aesthet Surg J . 2010;30(1):44-50. doi:10.1177/1090820X09358078
Sanuki J, Fukuma E, Uchida Y. Morphologic study of nipple-areola complex in 600 breasts . Aesthetic Plast Surg . 2009;33(3):295-297. doi:10.1007/s00266-008-9194-y
Al-Qattan MM, Aldakhil SS, Al-Hassan TS, Al-Qahtani A. Anthropometric breast measurement: analysis of the average breast in young nulliparous Saudi female population . Plast Reconstr Surg Glob Open . 2019;7(8):e2326. doi:10.1097/GOX.0000000000002326
Mokkapati PR, Gowda M, Deo S, Dhamija E, Thulkar S. Breast anthropometry—results of a prospective study among Indian breast cancer patients . Indian J Surg Oncol . 2020;11(1):28-34. doi:10.1007/s13193-019-01031-3
Tse G, Tan PH, Schmitt F. Anatomy and Physiology of the Breast. In Fine Needle Aspiration Cytology of the Breast (pp. 1-5). Berlin, Heidelberg: Springer Berlin Heidelberg.
Reisman T, Goldstein Z. Case report: induced lactation in a transgender woman . Transgend Health . 2018;3(1):24-26. doi:10.1089/trgh.2017.0044
García-Acosta JM, San Juan-Valdivia RM, Fernández-Martínez AD, Lorenzo-Rocha ND, Castro-Peraza ME. Trans* pregnancy and lactation: a literature review from a nursing perspective . Int J Environ Res Public Health . 2019;17(1):44. doi:10.3390/ijerph17010044
Holbrook J, Minocha J, Laumann A. Body piercing: complications and prevention of health risks . Am J Clin Dermatol . 2012;13(1):1-17. doi:10.2165/11593220-000000000-00000
Thapa S, Bhusal K. Hyperprolactinemia . StatPearls.
Stone K, Wheeler A. A review of anatomy, physiology, and benign pathology of the nipple . Ann Surg Oncol . 2015;22(10):3236-3240. doi:10.1245/s10434-015-4760-4
Ying S, Fang H, Qiao J. Erosive adenomatosis of the nipple: a clinical diagnostic challenge . Clin Cosmet Investig Dermatol . 2020;13:587-590. doi:10.2147/CCID.S260534
Lam E, Chan T, Wiseman SM. Breast abscess: evidence based management recommendations . Expert Rev Anti Infect Ther . 2014;12(7):753-762. doi:10.1586/14787210.2014.913982
Sisti A, Grimaldi L, Tassinari J, et al. Nipple-areola complex reconstruction techniques: a literature review . Eur J Surg Oncol . 2016;42(4):441-465. doi:10.1016/j.ejso.2016.01.003
Cha HG, Kwon JG, Kim EK, Lee HJ. Tattoo-only nipple-areola complex reconstruction: another option for plastic surgeons . J Plast Reconstr Aesthet Surg . 2020;73(4):696-702. doi:10.1016/j.bjps.2019.11.011
Boskey ER, Jolly D, Semnack MM, Tobias AM, Ganor O. Congruence is not cosmetic: denials of nipple grafts for chest reconstruction surgery . Plast Reconstr Surg Glob Open . 2019;7(4):e2145. doi:10.1097/GOX.0000000000002145
Trøstrup H, Saltvig I, Matzen SH. Current surgical techniques for nipple reduction: a literature review . JPRAS Open . 2019;21:48-55. doi:10.1016/j.jpra.2019.06.002
Garcia ES, Veiga DF, Sabino-Neto M, et al. Sensitivity of the nipple-areola complex and sexual function following reduction mammaplasty . Aesthet Surg J . 2015;35(7):NP193-NP202. doi:10.1093/asj/sjv034
Kraut RY, Brown E, Korownyk C, et al. The impact of breast reduction surgery on breastfeeding: Systematic review of observational studies . PLoS One . 2017;12(10):e0186591. doi:10.1371/journal.pone.0186591
Smallman A, Crittenden T, MiinYip J, Dean NR. Does nipple-areolar tattooing matter in breast reconstruction? A cohort study using the BREAST-Q . JPRAS Open . 2018;16:61-68. doi:10.1016/j.jpra.2018.01.003
Santosa KB, Qi J, Kim HM, et al. Comparing nipple-sparing mastectomy to secondary nipple reconstruction: a multi-institutional study . Ann Surg . 2019;10.1097/SLA.0000000000003577. doi:10.1097/SLA.0000000000003577
Yoshimura K, Momosawa A, Watanabe A, et al. Cosmetic color improvement of the nipple-areola complex by optimal use of tretinoin and hydroquinone . Dermatol Surg . 2002;28(12):1153-1158. doi:10.1046/j.1524-4725.2002.02097.x
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are·o·la

| \ ə-ˈrē-ə-lə

; ˌer-ē-ˈō-

, ˌa-rē- \

plural areolae \
ə-ˈrē-ə-ˌlē
, ˌer-ē-ˈō-ˌlē , ˌa-rē-
\ or areolas

: a small area between things or about something

especially

: a colored ring (as about the nipple, a vesicle, or a pustule)

areolar
\
ə-ˈrē-ə-lər

\
adjective

areolate
\
ə-ˈrē-ə-lət

\
adjective

Women with accessory breast tissue can have extra nipples or areolas ; this condition is called polythelia.

—

Maggie O'neill, Health.com , 12 June 2019
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