Folded Flap Technique for Nipple Reduction

Abstract Background Nipple hypertrophy is a common aesthetic concern that can cause psychological discomfort and disrupt breast harmony. Although many techniques exist for nipple reduction, they often have limitations in reducing all dimensions simultaneously and carry risks of deformity or impaired lactational function. Objectives The authors of this study aim to introduce and evaluate the effectiveness and safety of the “folded flap” technique, a simple, anatomically guided approach designed to achieve simultaneous reduction in nipple height, diameter, and base width while preserving a natural contour and function. Methods A retrospective analysis was performed on 61 patients (122 nipples) treated between January 2018 and December 2024 using the folded flap technique. The procedure involves clear, anatomically based preoperative marking, excision of a precise tissue block, placement of a 3-point key suture, and layered closure to achieve a natural cylindrical nipple shape. Postoperative follow-up was conducted at 1, 3, 6, and 12 months to evaluate aesthetic outcomes, complications, sensitivity, and lactational function. Results No intraoperative or major postoperative complications occurred. The average procedure time was 10 to 15 min. The mean reduction in nipple height and diameter was 40% to 70% of baseline, with additional narrowing of the base. Aesthetic outcomes were rated as stable and predictable. No cases of necrosis, deformity, significant scarring, or sensitivity loss were observed. Among 7 patients who became pregnant postoperatively, no breastfeeding difficulties were reported. Conclusions The folded flap technique is a safe, effective, and reproducible method for nipple reduction, offering precise simultaneous reduction of all key dimensions while maintaining a natural, balanced contour and minimizing risk of complications. Level of Evidence: 4 (Therapeutic)