The areola is a darker, pigmented disc of skin that surrounds the nipple. It is as individual in appearance including size and color as hair color or body type. The appearance of the areola differs from person to person and also changes over time. Both the pigmentation and the size of the areola change throughout life.
Anatomy of the areola
Breast skin is made up of three distinct parts: the nipple, the areola, and the skin as a whole. There are several milk ducts in the nipple .
It is surrounded by an areola, also known as the areola of the breast. In terms of its structural complexity, it is a round, dark pigmented area somewhere between the nipple and the surrounding skin. The mean diameter of the areolas is 15-16 millimeters (mm), although they increase in size during pregnancy and lactation.
The nipple pigment is made up of melanocytes . Color may change over time, depending on stimulation. For example, the pigment of the areola usually darkens during pregnancy and breastfeeding and then remains darker.
The average size of the areola varies greatly depending on the person and life expectancy. In women, the size of the areola increases significantly during puberty. Then it can increase again if the woman becomes pregnant and begins to breastfeed. The size of the areola tends to increase with the size of the breast, and the larger areola may be slightly less tender to the touch.
Areola size studies are generally performed in relatively small populations of a specific ethnicity and age:
- A previous study of the diameter of the areola in Turkish girls showed that the diameter increased from 15 to 40 mm during puberty. The fully developed group had a standard deviation of almost 10 mm.
- A study of Turkish women aged 18-26 found an average diameter of 36mm with a standard deviation of 9mm.
- A study of the breasts of adult Japanese women showed that the average diameter of the areola is 40 mm with a range of 20 to 70 mm.
- A study of Saudi women who had never been pregnant found that the average nipple diameter is 45mm.
- A study of Indian women found a range of 5 to 80mm.
As a general rule, men have fewer areolas than women. (This is why the areola-nipple complex changes during upper surgery .) However, the size of the areola-nipple complex also varies significantly in men. A study in hospitalized British men found a size range of 9 to 44mm, with an average of 27mm.
Small areolas are normal. The middle areolas are normal. Large areolas are normal. The size of the areola is the same individual as the height, or the difference in the width of the shoulders and hips of a person. The size of the areola is not a cause for concern, and changing the size of the areola over time does not mean that something is wrong.
There are several different structures on the areola.
Montgomery tubercles are small oil-producing sebaceous glands that look like tiny tubercles on the areola. These bumps get bigger during pregnancy and breastfeeding and can look like little pimples. Then they usually get smaller again after breastfeeding ends.
The function of Montgomery tubers is to release an oily substance to lubricate and protect the nipples. They also release 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 muscles, and various types of connective tissue. There are also a large number of blood vessels.
Stimulating the areola can promote erection of both the nipple and areola. This erectile and contraction function helps empty the nipples of milk during breastfeeding. The erectile function of the areola can also make it easier for a breastfeeding baby to breastfeed.
Breastfeeding is possible for any gender.
Although the nipples and areolas in men and women vary considerably in size, their structure and functionality are basically the same. With proper hormonal stimulation, people of any gender or sex can breastfeed.
A case report published in 2018 described a transgender woman who breastfed her baby and was the sole source of food for six weeks. Transgender men can breastfeed too.
Cisgender men can also have milk production. It can be drug-induced or occur with certain hormonal conditions or other types of stimulation. This is called galactorrhea.
The size of the areola changes throughout life
The areola changes significantly in size throughout life. The first noticeable change occurs around puberty. As the breasts begin to grow, the pigmented area of the areola also enlarges. As the breasts continue to grow, the nipple and areola eventually form a raised area, not just a darker one.
During pregnancy and breastfeeding, the areola begins to grow back and also becomes darker. This corresponds to a time when breast size also increases.
However, after the end of lactation, the size of the breasts decreases, and the size and color of the areola, as a rule, remain the same. The areola may become slightly smaller and lighter in color, but it is unlikely to return to the size and color it was before pregnancy, and it may not change at all.
Research on areola changes during menopause is virtually non-existent.
When to see a doctor
Only some types of areola changes require medical intervention or an examination by a doctor. Don't worry about simple changes in size or color, especially during periods of hormonal changes.
This is also true if one areola is larger than the other; many women have different areola sizes. As a general rule, it is necessary to consult a doctor about changes in the areola only if they are associated with 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 looks like thick or flaky skin on the nipples and sometimes uncomfortable, raised bumps. In some cases, people can develop eczema on the nipples when they do not have other signs of atopic dermatitis.
This happens most often during breastfeeding. Nipple eczema usually occurs on both breasts at the same time.
Paget's nipple disease
Paget's nipple disease is a very rare type of breast cancer. At first, it may appear as a single lump or lesion that grows and spreads over time. This injury can cause itching or ulceration.
Lumps and bumps that appear on a single areola, increase in size over time, and expand along the areola should be evaluated by biopsy. For Paget's disease, a lumpectomy may be required.
Erosive adenomatosis is usually a benign ulcerative lesion of the nipple. It is very rare and is rarely associated with cancer. Other benign tumors of the areola-nipple complex may also appear. Surgical treatment may be necessary.
Subareolar / periareolar infection
Abscesses and infection can occur both under the areola ( subareolar ) and around it (periareolar). It is more common in pregnant or lactating women. Infections during pregnancy and lactation tend to occur in young women, while those that occur outside the context of pregnancy tend to occur closer to menopause.
These infections are usually diagnosed due to pain or discomfort in the chest area. There may also be a swollen area under the areola or a lump. Any abscess may require drainage and antibiotic treatment.
Can the areola be changed?
There is no medical reason why someone should change the size or color of the areolas. However, people can change the appearance of the areola to solve cosmetic problems.
People who have undergone breast reconstruction after a mastectomy may also need reconstruction of the nipples and areolas. and / or nipple tattoo . In the context of breast reconstruction after cancer, nipple reconstruction is considered medically necessary and not cosmetic. Therefore, it must be insured.
Surgery can be used to correct the size of the nipples and areolas. This surgery is most often done in the context of breast reduction, but it can also be done on your own.
Surgery used to change the size and shape of the areola can permanently desensitize or eliminate sensation in the nipple and can affect sexual sensation and pleasure. It can also affect a person's ability to breastfeed.
Reconstruction after mastectomy
Research has shown that nipple tattoos and nipple reconstruction can increase satisfaction with the reconstructed breast if nipple preservation techniques are not used in the initial surgery.
Nipple-sparing mastectomy is not always an appropriate type of breast cancer surgery, depending on the type and extent of the cancer.
Medications to lighten the skin
While there are several skin lightening creams available to use on the nipples, there is very little research on their safety and effectiveness. Small studies that exist show that, at least in some cases, the use of these creams can lead to increased pigmentation rather than lightening.
Formulations that are more likely to affect pigmentation are also more likely to cause skin damage, and these medications should not be used except under the supervision of a dermatologist.
Should you change your areola?
While surgical and medical treatments are possible to change the size and color of the areolas, people considering these options should think carefully about whether they are a good idea.
These treatments can make the nipples less sensitive and affect the pleasure of touching. They can make breastfeeding difficult. This is a huge risk for purely cosmetic reasons, although it might make sense to some people.
Before undergoing any type of surgery or treatment to change the nipple and areola, people should think about why they are considering it. What messages do you get about what your body should look like?
Do these messages reflect racist, age, or dimensional beliefs about ideal areola size or color? Are they adhering to patriarchal beauty beliefs, trying to make their sexual partner happy, or do they really feel like they are more interested in changes to their bodies?
People have many different beliefs about cosmetic surgery. It can have a positive impact on people's lives, but it can also cause discomfort and changes in function without significantly improving daily life.
Breast reduction can dramatically reduce pain and quality of life and increase people's satisfaction with their appearance. However, procedures to correct changes in the size and color of the areola can only improve a person's satisfaction with their appearance.
This can be more difficult to reconcile with the possibility of sensory changes and other long-term function concerns.
Get the word of drug information
The areola-nipple complex is an important part of the breast. This structure is found in people of all ages and genders, and its appearance is very diverse. Although the size of the areola generally depends on the size of the breast, some people have larger nipples and others smaller ones. This is true and normal for both men and women.
People who are pregnant and breastfeeding often see an increase in the size of the nipples and areolas. They can also become darker and more visible. This is not a health concern and should not cause concern or anxiety.
The color and shape of the nipples change throughout a person's life, and this is a natural consequence of hormonal changes and aging. Regardless of a person's size, color, or gender, nipples and areolas serve the same range of potential functions.
If they are more or less than average, this is not a reason to seek a change. If they are more brown than pink, or darker than lighter, this does not mean that something is wrong.