In anatomy, the term areola, plural areolae, (diminutive of Latin area, "open place") is used to describe any small circular area such as the colored skin surrounding the nipple. While it is most commonly used to describe the pigmented area around the human nipple (areola mammae), it can also be used to describe other small circular areas such as the inflamed region surrounding a pimple.
The Merriam-Webster dictionary notes two pronunciations for the term areola; aREola and areOla.
The reason the color of the areola differs from that of the rest of the breast is that the areola roughly delineates where the ducts of the mammary glands are. Careful inspection of a mature human female nipple will reveal several small openings arranged radially around the tip of the nipple (lactiferous ducts) from where milk is released during lactation. Other small openings in the areola are sebaceous glands known as Montgomery's glands (or glands of Montgomery) which provide lubrication to protect the area around the nipple and assist with suckling during lactation. These can be quite obvious and raised above the surface of the areola, giving the appearance of "goose-flesh".
Two polymers contribute to the color of the areola in humans - brown eumelanin and pheomelanin, a red pigment. The relative amount of these pigments determines the color of the areola, which can vary greatly, ranging from pale pink to dark brown, but generally tending to be paler among people with lighter skin tones and darker among people with darker skin tones. An individual's areolae may also change color over time in response to hormonal changes caused by menstruation, certain medications, and aging. Most notably, the areolae may darken substantially during pregnancy. Some regression to the original color may occur after the baby is born but, again, this varies from individual to individual.
The size and shape of areolae is also highly variable, with those of sexually mature women usually being larger than those of men and prepubescent girls. Human areolae are mostly circular in shape but many women and some men have areolae that are noticeably elliptical.
The areolae of most men is around 25 mm (1 in) in diameter while those of sexually-mature women may range up to 100 mm (4 in) or more in diameter, with average sizes around 30 mm (1 3/8 in). The areola of women who are lactating or who have particularly large breasts may be even larger.
Nipple reconstruction is usually delayed until after the breast mound reconstruction is completed so that the positioning can be planned precisely. There are several methods of reconstructing the nipple-areolar complex, including:
- Nipple-Areolar Composite Graft (Sharing) - if the contralateral breast has not been reconstructed and the nipple and areolar are sufficiently large, tissue may be harvested and used to recreate the nipple-areolar complex on the reconstructed side.
- Local Tissue Flaps - a nipple may be created by raising a small flap in the target area and producing a raised mound of skin. To create an areola, a circular incision may be made around the new nipple and sutured back again. The nipple and areolar region may then be tattooed to produce a realistic colour match with the contralateral breast.
- Local Tissue Flaps With Use of AlloDerm - as above, a nipple may be created by raising a small flap in the target area and producing a raised mound of skin. AlloDerm (cadaveric dermis) can then be inserted into the core of the new nipple acting like a "strut" which may help maintain the projection of the nipple for a longer period of time. The nipple and areolar region may then be tattooed later.
One of the challenges in breast reconstruction is to match the reconstructed breast to the mature breast on the other side (often fairly 'ptotic' - droopy.) This often requires a lift (mastopexy), reduction, or augmentation of the other breast.
Follow-up and Recovery
Recovery from implant-based reconstruction is generally faster than with flap-based reconstructions, but both take at least three to six weeks to recover and both require follow-up surgeries in order to construct a new areola and nipple. All recipients of these operations should refrain from strenuous sports, overhead lifting and sexual activity during the recovery period (three to six weeks). TRAM flap patients can show abdominal muscle weakness on EMG studies, but clinically most patients return to normal activities after recovery.
There is little information about upper body exercise post-mastectomy. Issues such as simple mastectomy, mastectomy with reconstruction, mastectomy with lymph node excision and reconstruction all factor into limitations to amount and extent of upper body exercise. Generally, cardiac exercise (treadmill, walking, etc.) are approved for rehabilitation post-surgery and for weight control. Women who have undergone breast reconstruction must still be followed for local or regional recurrence of their cancer with manual exams of the breast/chest wall and axilla.