Cinnamon Roll Technique with WALANT for Nipple Reduction

Nipple hypertrophy is a common esthetic problem in Asian women. Many patients are uncomfortable and seek plastic surgeons for correction. Although several reduction methods have been published, the new nipple size is not always decided by patients under conventional anesthesia. We describe a novel cinnamon roll technique with wide-awake local anesthesia no tourniquet (WALANT) to decrease pain, provide a bloodless field and allow on-table discussion of the ideal nipple size during surgery.

Between November 2015 and October 2022, fifteen patients with 30 nipples were enrolled. The patient's characteristic data, nipple height and width, and VAS while infiltration were recorded. Aesthetic results were evaluated by rating a satisfactory score from 0 to 10 at follow-up. Sensory recovery was also evaluated for 1, 3, 6, and 12 months sequentially after the surgery.

Before surgery, the mean diameter and height of the nipples were 13.2 ± 1.8 mm and 12 ± 2.2 mm, respectively. Immediately after surgery, the mean diameter and height of the nipples were 8.8 ± 1.2 mm and 8.7 ± 1.2 mm, respectively. The mean VAS while infiltration was 1.3 ± 0.5 and the mean satisfactory score at the latest clinic follow-up was 9.3 ± 0.6. No complications such as nipple necrosis, infection, numbness or hypertrophic scar occurred. The mean clinical follow-up period was 3.4 months.

Cinnamon roll technique with WALANT is a simple, safe and reliable method with short learning curve and high satisfaction. Our technique offers a chance for patients to control subjective pleasing size of their own nipples.

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