Typically when these operations are done, the areola, the pigmented skin around the nipple, is downsized.
We do this by using a circular metal instrument, a “cookie cutter”, that centers over the nipple. They come in different sizes, usually 38mm, 42mm, or 45mm. We then mark the skin around the cookie cutter and make the cut along the lines.
The problem is that the skin is usually cold from being exposed. This causes the nipple to become erect and the skin of the areola contracts. If this happens differentially, it will leave the areolae different sizes after the skin relaxes and warms.
These problems are easy to fix and can be taken care of in the office.
Lee Corbett, MD