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A Quick Breast Revision Procedure Can Correct Inverted Nipples

March 15, 2006,

By Dr. Grant Stevens from About Plastic Surgery

Inverted nipples are a readily correctable cosmetic problem. Breast revision surgery can provide a permanent solution to this condition.

Breast revision surgery most often focuses on enlarging or reducing the overall size of breasts and correcting drooping. However, a small percentage of the population has a different reason to visit a plastic surgery center for a cosmetic breast consultation. These are women who have inverted nipples. This condition is usually painless, but it can make breasts look a little odd. When only one nipple is inverted, this can cause breasts to appear asymmetrical. Nipple inversion can also make breast feeding more challenging. Women who have inverted nipples sometimes feel embarrassed or awkward about the appearance of their breasts, especially during sexual encounters.

Causes of Nipple Inversion

Some women (and some men) are simply born with inverted nipples due to the structure of the nipple itself or the surrounding skin and underlying tissue. Others develop this condition due to changes in and around the nipple over time. For example, the milk ducts and other fibrous tissues in the nipple may become shortened as a result of inflammation. Scar tissue can also develop causing permanent constriction. This sometimes happens after a biopsy when breast tissue near the nipple is removed.

Significant changes in the size and amount of drooping of the breast may also make a nipple appear inverted. Although most women report their nipples become more pronounced due to breast feeding, some say their nipples actually retract. In very rare cases, nipple inversion can be a sign of breast cancer. If you develop inverted nipples with no apparent cause, schedule an exam with your physician to rule out this possibility.

Levels of Nipple Inversion

If you have a breast revision consultation at a plastic surgery center, your surgeon will evaluate your level of nipple inversion based on a scale of 1-3. The least severe level of inversion is referred to as having “shy” nipples. This means the nipples are often inverted but will generally respond to cold or tactile stimulation by protruding normally. They may stay out for a while before retracting again.

At the second level, nipples stay in all the time. Strong suction may cause them to pop out briefly, but they will quickly invert again. At the third and most severe level of inversion, even vigorous manipulation may not make the nipple project at all due to severe tissue constriction or scarring.

Temporary Fixes

Many patients with level 1 or 2 nipple inversion try non-surgical options before seeking breast revision. Suction devices (such as the Avent Niplette) that place constant vacuum pressure on the nipple are a common choice. This type of device is advertised as providing a permanent solution for inverted nipples. However, since it does not correct the underlying structural issue causing the nipples to retract, the effects will wear off once the patient stops wearing the device.

Inverted nipples may also be pierced with a dumbbell shaped nipple ring. Some women have this done at a piercing parlor and others see a medical professional for the procedure. There does not appear to be well documented evidence that this approach results in continued correction once the piercing is removed. However, it does cause scarring, an undesirable side-effect that can further damage the cosmetic appearance of the nipple.

Breast Revision for Nipple Inversion

At one time, the usual surgical solution for nipple inversion involved severing the milk ducts to release the nipple. There are still plastic surgeons who use this method. Although effective, this approach is unnecessarily destructive and makes it impossible for a woman to breastfeed afterward. A newer technique is now available that preserves the milk ducts and focuses on releasing the surrounding fibers that are holding the nipple in. Instead of simply severing the connective tissue in the nipple, the fibers are spread or stretched. This is achieved through a small incision in the areola while the nipple is held in the “out” position.

Several lines of dissolving sutures are inserted under the skin to hold the nipple in the desired, projecting position. Protective devices are placed over the nipples for a couple of days after the surgery to hold the nipples in position and ensure they don’t retract again during healing. The sutures dissolve within a couple of weeks. Any scarring from this minimally invasive procedure is usually not noticeable since the incision is small. The bumpy surface and natural color variations in the nipple and areola also help mask the scar. The results of the procedure are immediately noticeable. Since the surgery directly addresses the tissue abnormalities that were keeping the nipple inverted, the results have a good chance of being permanent.

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