Buffalo hump (fat accumulation on upper back and shoulder) and Lipoma (benign fatty tumours) are structurally different, and so are their treatment approaches.
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Chandler Bing wouldn't be Chandler without his quips and, some may say, his #nubbin.
If you are a fan of Friends, you would recognise the pic above. Yes, that's from Season 2, Episode 4, who was at the coffee shop scene when Ross placed a coffee cup at Chandler's chest to indicate that Chandler's third nipple was lactating.
Julie: You know, in some cultures, having a third nipple is actually a sign of virility. You get the best huts and women dance naked around you.
Chandler: Huh. Are any of these cultures perchance in the tri-state area?
Do you remember what his friends were asking Chandler after Monica revealed his third nipples -- What does it look like? Does it have hair on it? What happens if you flick it? Does it do anything special?
Chandler dismissed it by saying his nubbin is just a "tiny bump; it's totally useless."
So, are third nipples really harmless and completely useless? Do they really lactate? Do some people really find third nipples sexy in some cultures?
Is a third nipple a "rare disease"?
Nubbin means a small lump or residual part, as per the Oxford Dictionary. Medically, the third nipple is called a supernumerary nipple – that is, a number of nipples greater than two. This condition was highlighted by a researcher called Leichtenstern in a German scientific journal in 1878. The scientist estimated that third nipples are common and can occur in one or 500 humans, men and women alike . Even the beautiful Anne Boleyn, the wife of King Henry VIII, was rumoured to have a third breast!
Third nipples appear to be more common in men than in women  and can be found in:
- 0.22% of Hungarian population
- 0.6% of white American infants
- 1.63% of Black American infants
- 2.5% of Israeli infants
- 4.7% of Israeli-Arabic children
- 5.6% of German children
- 5% of Japanese women
- 1.6% of Japanese men
- fewer than 200,000 people within the United States
The third (supernumerary) nipple categories
In 1915, Professor Yrjö Kajava classified supernumerary nipples into eight categories according to the types of tissue present.
- Category 1: Presence of third nipple, areola and underlying breast tissue.
- Category 2: Presence of third nipple and underlying breast tissue only
- Category 3: Presence of breast tissue and an areola only
- Category 4: Presence of breast tissue only
- Category 5: Presence of nipple, areola and fatty tissue only
- Category 6: Presence of nipple only. Also known as "polythelia"
Other supernumerary nipples classification
Healthcare professionals have classified supernumerary nipples according to their size, shape and tissue components. The primary types include:
How a third nipple is formed in the embryonic development
To better understand supernumerary nipples, let's take a look at how nipples are formed in the embryonic stage.
During the fourth week of pregnancy, ectoderm (which develops into skin, hair, nails, etc) thickens and completely develops into milk lines or mammary lines that stretch from the armpits to the groin. When the mammary ridges don't disappear completely, a supernumerary nipple or breast is formed. Most of them are located below the regular nipples; however, it is not unusual if it is formed above.
Is third nipple a sign of virility?
So, is Julie right about third nipples and virility in some cultures? Well, she is not wrong.
In ancient Roman mythology, Diana of Ephesus, or ‘Artemis’ as the Ancient Greeks called her, is a multi-breasted fertility deity. She was extremely popular in the ancient world. Her statues often showcase rows of breasts on her chest to symbolise her virility – although modern hypotheses suggest that those breasts might be bulls testicles, grapes, dates or eggs served to her as offerings from worshippers. Built at around 550 BCE, her temple at Ephesus, the Temple of Artemis, also called Artemisium, now in western Turkey, was one of the seven wonders of the ancient world.
In men with extra nipples, it was believed then that "supernumerary nipples in men were a sign of virility and endowed them with divine powers.” 
Medically today, no relationship between virility and supernumerary nipples was ever found.
What does a third nipple look like?
Extra nipples are barely noticeable as they have often been mistaken for skin tags, moles or even beauty marks.
Crazy medical fact: Extra nipples can also be found ANYWHERE on the body, like the hands, perineum, inner thighs and feet. In such cases, the nubbins are identified medically as ectopic supernumerary nipples.
Third nipple removal procedure: What, How, Recovery
Most who have supernumerary nipples ignore them or may not even notice they have one. Occasionally, the third nipple is only noticed when hormonal changes occur during puberty, menstruation, or pregnancy.
During pregnancy, the third nipple and/or areola may look darker, feel tender, lactate or swell. They are an indication of any underlying medical conditions, but you may want to get them removed if you or your partner don't like the way they look or feel, like Chandler, or for other cosmetic reasons.
In Friends Season 3 Episode 14, Chandler, after he broke up with Ginger, said, "just had me a little nubbinectomy". What does he mean? Chandler had surgery to remove his "Third Nipple". Since the third nipple is called a nubbin, a nubbinectomy would mean surgery to get one removed. And he had it done within a day.
In reality, how does third nipple removal actually work?
The procedure is relatively straightforward. During the third nipple removal, which is performed under local anaesthetic, a small incision no longer than 4mm will be made. The nipple is then removed. Surgical stitches will be used to close the incision. Scarring will be kept to the bare minimum.
You are able to return home immediately after the surgery. Swelling, bruising and swelling after the surgery are to be expected. Pain relief medication will be prescribed to help you with discomfort and soreness.
Third nipple on a third breast: What to do
Having a third breast means that the area contains underlying breast tissue. A fully-formed breast, this third breast is also known as ‘Polymastia’ (supernumerary breasts)" or ‘axillary/accessory breast tissue.’
This person is considered to be under Category 1 (Presence of nipple, areola and underlying breast tissue). If this happens in a woman, she is likely to go through the same hormonal changes, like lactation during pregnancy or become tender during menstruation, as her other two breasts. She is also at risk of breast-related diseases .
According to an American Journal of Roentgenology study, the proven method of accessory breast removal is surgical excision . If there is fatty tissue present and to achieve a smooth and natural contour, it is better to combine the gland excision with liposuction.
Different surgeries for different issues
Category 1: Presence of third nipple, areola and underlying breast tissue.
Type of surgeries: Combination of accessory breast removal, nipple excision and liposuction
Category 2: Presence of third nipple and underlying breast tissue only
Type of surgeries: Accessory breast removal
Category 3: Presence of breast tissue and an areola only
Type of surgeries: Accessory breast removal
Category 4: Presence of breast tissue only
Type of surgeries: Accessory breast removal
Category 5: Presence of nipple, areola and fatty tissue
Type of surgeries: Combination of nipple excision and liposuction
Category 6: Presence of nipple only. Also known as "polythelia"
Type of surgeries: Nipple excision
About Dr Ivan Puah
Our Medical Director, Dr Ivan Puah, has almost two decades of experience in surgical body sculpting procedures including accessory breast removal. He is accredited by the Ministry of Health Singapore to perform liposuction. Having received dedicated training in gynecomastia surgery and liposuction in the United States, Argentina and Italy, Dr Puah has created two patented surgical techniques to perfect the body sculpting procedures with minimal scarring, downtime, and intrusion:
- Gynecomastia Surgery with 360 degrees Glandular Tissue Dissection (360 degrees GTD®) technique to flatten enlarged male chest and to achieve a well-defined and masculine chest
- MDC-Sculpt®️ Lipo technique, multi-dimensional contouring approach that targets multi-fat layers, creating aesthetic pleasing body shapes and curves while tightening loose skin.
Book a consultation to better understand your condition and the permanent and safe solution that Amaris B. Clinic Singapore can provide.