A Large Areola: Normal or Not?

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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.

Breast anatomy detailed diagram
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Anatomy of the Areola

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.

Average Size

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

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

  • An older study of areola diameter in Turkish girls found that the diameter increased from 15-40 mm across the span of pubertal development. There was a standard deviation of almost 10 mm in the fully developed group.
  • A study of Turkish women between the ages of 18-26 found a mean diameter of 36 mm with a standard deviation of 9 mm.
  • A study looking at the breasts of adult Japanese women found a mean diameter of the areola of 40 mm with a range of 20 mm to 70 mm.
  • A study of Saudi women who had never been pregnant found a mean nipple diameter of 45 mm.
  • A study of Indian women found a range of 5-80 mm.

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.

Size Concerns

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

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.

Underlying Structure

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. The erectile function of the areola can also make it easier for a suckling infant.

Breastfeeding Is Possible for Any Sex

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. Transgender men can also breastfeed.

Cisgender men may also experience milk production. It can be induced with medication or occur with certain hormonal conditions or other types of stimulation. This is referred to as galactorrhea.

Areola Size Changes Over the Lifespan

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. 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.

When to See a Doctor

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

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

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. Paget’s disease of the nipple may need to be treated with lumpectomy.

Erosive Adenomatosis

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

Subareolar/Periareolar Infection

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.

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.

Can You Change Your Areola?

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 and/or nipple tattooing. In the context of breast reconstruction after cancer, nipple reconstruction is considered to be medically necessary and not cosmetic. It should therefore be covered by insurance.

Surgery

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.

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. It may also impact a person’s ability to breastfeed.

Post-Mastectomy Reconstruction

Research has found that both nipple tattooing and nipple reconstruction can improve satisfaction with the reconstructed breast when nipple-sparing techniques are not used in the original surgery.

Nipple-sparing mastectomy is not always an appropriate type of breast cancer surgery, depending on the type and extent of the cancer.

Skin-Lightening Medications

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.

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.

Should You Change Your Areola?

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. 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.

A Word From Verywell

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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