Inverted nipples can pose aesthetic and functional problems, especially for young women. The objectives of inverted nipple correction are both sufficient aesthetic projection of the nipple and postoperative functional preservation of the lactiferous ducts. Recurrence of nipple inversion is still an unsolved problem in many cases. We present a new nipple suspension technique using nipple- and areola-based dermal flaps for correcting inverted nipples and preserving the lactiferous duct to minimize the risk of recurrence.
We corrected six inverted nipples in three patients, which were classified as grade II using the Han and Hong classification of nipple inversion. The anteroposterior and lateral medical-quality photographs of the respective patients were identified for nipple protrusion and recurrence during a 6-month follow-up period to evaluate aesthetical goal and assess the sensitivity of the nipple to confirm preservation of the main lactiferous ducts. Surgical details are described within the main text.
Preoperative and postoperative photography revealed good nipple protrusion during the 6-month follow-up period without any complications such as skin necrosis and recurrence. We were unable to directly identify breast-feeding function because all three patients were young and unmarried women. However, we assumed preservation of the main lactiferous duct since no nipple sensory change was identified in the postoperative examination when compared with the preoperative examination.
With this method, we were able to confirm the hardness of the column and minimize the injury of the main lactiferous duct.
An inverted nipple is a condition in which the nipple is buried below the plane of the areola, characterized by short galactophorous ducts, periductal fibrosis, and lack of soft tissue under the nipple base. This deformity is a relatively common problem, with reported prevalence ranging from 1.8 to 3.3% [
In this article, we present a new nipple suspension technique using nipple- and areola-based dermal flaps for correcting inverted nipples and preserving the lactiferous duct to minimize the risk of recurrence.
We corrected six inverted nipples in three patients, which were classified as grade II using the Han and Hong classification of nipple inversion [
Two diamond-shaped flaps were designed at the 3- and 9-o’clock positions of the nipple. Each flap was placed between the areola and the nipple (
Preoperative and postoperative photography revealed good nipple protrusion during the 6-month follow-up period without any complications such as skin necrosis and recurrence (
In this study, we were unable to directly identify breast-feeding function because all three patients were young and unmarried women. However, we assumed preservation of the main lactiferous duct since no nipple sensory change was identified in the postoperative examination when compared with the preoperative examination.
According to the Han and Hong classification [
Corrective surgical procedures of inverted nipples have two basic objectives. First, adequate release of periductal fibrous tissues and secondly, preservation of the lactiferous duct.
In most of the previously introduced techniques, areolar dermal flap techniques were used to fill the dead space underneath the nipple that was developed after sufficient release of periductal fibrous tissues. Elsahy [
For the proposed modification of the areolar dermal flap technique, we placed the axis of the flap at the nipple portion rather than the areola to minimize nipple torsion. Our focus was to reduce the nipple stalk diameter by transverse suturing on the opposite side and to improve nipple projection by maintaining nipple volume using the upper portion of the flap. The lower flap was used to fill the dead space resulting from release of the fibrous band.
By utilizing the blood supply of only one single edge of the flap, limited circulation would be possible for the lower flap. However, the main blood supply of the nipple areolar complex is derived from the external and internal mammary arteries that transverse subcutaneous tissues. As nutrient vessels in the subcutaneous tissues supply the nipple, we could preserve the blood supply of the nipple-areolar complex transposition flap based on the dermal pedicle [
Another important aspect to consider in inverted nipple correction surgery is lactation. In our procedure, a limited size of the dermal flap was buried and anchored to maintain lactation [
This study has several limitations. First, the shape of the nipple could appear embossed in the short-term follow-up period. A narrowed nipple neck and flap insertion at both the upper and lower portion of the nipple induced postoperative shape deformity. However, in the 6-month follow-up period, the shape became flattened and normalized. In addition, the number of cases was too small; thus, more cases are needed to reach a universal conclusion.
We designed a diamond-shaped nipple-areolar based dermal flap to correct moderately inverted nipples. In this study, nipple protrusion was aesthetically acceptable in all patients postoperatively. Unlike procedures introduced by other surgeons previously, we set the axis of the flap at the nipple portion and wrapped stalk. In addition, nipple stalk diameter was reduced, and we were able to increase nipple volume and fill the dead space in the lower portion of the nipple.
With this method, we were able to confirm the hardness of the column and minimize the injury of the main lactiferous duct. Therefore, this technique would be efficient in the treatment of moderately inverted nipples and can be considered as an option for surgeons who commonly deal with this pathology.
No potential conflict of interest relevant to this article was reported.
Patients provided written consent for the use of their images.
Schematic illustration of operative procedure.
Schematic diagram of operative procedure.
Preoperative photographic finding.
Postoperative photographic finding.