Purpose:
Inverted nipple, defined as a non-projectile nipple, is estimated to affect 2-10% of women. This pathologic condition could be congenital or acquired, unilateral or bilateral. Congenital type is the most common and acquired type is often associated with mammary carcinoma, mastitis or breast surgery. It not only causes aesthetic problem but also functional and psychological consequences. Numerous surgical techniques have been discussed to treat inverted nipple. The optimal goal of these procedures includes giving a good shape of nipple, preserving breast feeding and sensation, and avoiding recurrence. We present our surgical techniques with dermal flap to correct nipple inversion and share our experiences.
Materials and Methods:
We performed a retrospective chart review of inverted nipple treated by surgical intervention with dermal flap by one surgeon from April 2014 and September 2021. The results were evaluated including post-operative complications, recurrence and aesthetic outcome. Our surgical techniques consist of temporary traction suture to evert the nipple, a small incision at junction of the nipple and the areola, dermal-triangular flap creation over the opposite side of nipple, blunt dissection below the nipple to release the fibrous tissue, switch the dermal-triangular flap to the contralateral side through the tunnel below the nipple. Solid fixation is the key factor of success. We did pressure test to make sure the reliability of fixation and the traction suture will last for 10-14 days.
Results:
There are total 53 inverted nipples in 34 patients treated with dermal flap correction. Nineteen (55.9%) patients had congenital bilateral inverted nipples, Fifteen (44.1%) had congenital unilateral inverted nipples. The ages of patients ranged from 21 to 59 years (mean age, 29.9 years), with mean Body Mass Index (BMI) 20.53 (17.4 to 33.04). Mean follow-up time was 145 days (9 to 987 days). According to Han and Hong’s classification, grade II accounted for 17.0% (9 of 53 nipples) and grade III 83.0% (44 of 53 nipples). Six recurrences have been observed, the recurrence rate was 11.3%. There was no immediate or delayed post-operative complications such as nipple necrosis, infection, or hematoma and all patients were satisfied with the aesthetic outcomes.
Conclusion:
Despite various strategies have been introduced to correct inverted nipple, there was no gold standard treatment. We believe that the dermal-triangular flap could be a reliable method which could maintain nipple projection by using dermal flap as a support after releasing the fibrotic tissue perpendicular to the nipple. And the incisions at junction of the nipple and the areola also leads to invisible scars.