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Non-Binary Nipple and Areola Options

In this content, we’re going to define different top surgery nipple and areola options that are generally considered to appear like they underwent an androgenic development (assigned male at birth pubertal period). After defining that we’ll explain how those same techniques could be modified to best fit the needs of a non-binary patient. If you’re unsure of what non-binary top surgery is, please read the introduction first so you can get the most out of the content below.  

Before we get into specifics it’s important to make clear the difference between the nipple and the areola. The areolas are the wide (usually circular) pigmented area that also contains the nipple. The nipple (in plastic surgery terms) is the only part that projects outward from the chest and is usually somewhat cylinder shaped. 

Features of Binary Male Appearing Nipples and Areolas

During a top surgery procedure, the areolas are usually resized to the diameter of 22mm (about the size of a nickel) and is most commonly made to be circular. 22 mm is the average size of someone who was assigned male at birth (AMAB). 

• Projection: For Double Incision top surgery, the degree of projection of the nipples is dramatically reduced. This is a necessary step as part of the nipple grafting procedure. However, in other procedures such as Keyhole or Periareolar top surgery, the nipple is not typically reduced though the areolas are typically reduced (in the periareolar procedure) 
• Size: Most who wish to have a more AMAB appearing chest usually opt for considerably smaller areola (22 mm in diameter) and a considerably less projected nipple 
• Location: A typical location of a AMAB areola would be approximately 3 cm inside and also superior to the pectoralis major muscle border. Though there are a number of calculations that try to define the optimal location, ultimately it is the surgeon’s sense of aesthetics which primarily determines the best location for the nipple at the time of the procedure. Certainly, a degree of obsession on the part of the surgeon about placement and symmetry is important to getting a good symmetrical result. 

Features of Non-Binary Appearing Nipples and Areolas

Most often, if a non-binary individual wants to have a less binary appearing areola, they may choose a size that is slightly larger in diameter (usually 25 to 26 mm). This slightly larger areola options is about the size of an American quarter or a European One Euro coin. 

• Projection: Non-binary individuals may also wish to maintain more projection of the nipples. Nipple projection can be controlled to some degree with the free nipple grafting procedure, but the grafting procedure does require that at least a considerable amount of deprojection be performed as part of the preparation of the nipple graft 
• Size: For those wanting to have larger diameter areolas it’s important to note that beyond about 30 mm in diameter the areola can begin to become more feminine in appearance 
• Location: Non-binary folks may wish to have a location of the nipple areola more complex, so that is either slightly more narrow than usual or higher than usual that of someone wanting to obtain a male appearing result. Dr. Mosser does find that when patients choose a wider areola, a slightly higher placement seems to be overall aesthetically most pleasing 
• No Nipples: It’s very important to mention that some non-binary individuals may not want to have any nipples at all as a part of their procedure. This would require the procedure to be a double incision procedure but one in which we would avoid using the free nipple grafts altogether. Some individuals wish to never have any nipples on their chest, and other individuals will tattoo nipples and areolas on their chest later in life. It is interesting to note that there are some outstandingly well designed temporary stick-on areolas made of silicone which can be attached to the chest as when desired 

In Conclusion

If you’re interested in customizing a top surgery procedure so the end results feels or appears more non-binary to you, please read this additional content on non-binary incision and chest contouring options.