Correction of Inverted Nipple: An Alternative Method Using Continuous Elastic Outside Distraction

Abstract

Inverted nipple, which is defined as a nipple located on a plane lower than the areola, presents both functional and cosmetic problems. It is a source of repeated irritation and inflammation and interferes with nursing. In addition, its abnormal appearance may cause psychologic distress. With consideration of its underlying pathophysiologic components and severity, a number of techniques have been introduced for correction of this anomaly. Most of these techniques involve extensive skin incision around the nipple that may jeopardize the blood and nerve supply to the nipple or create much scar tissue that is esthetically objectionable. For correcting the inverted nipple, the authors introduce an alternative, simple method using continuous elastic outside distraction. Compared with other methods using outside distraction, the authors used an adjustable elastic instrument made of steel wire, spring, and plastic syringe; continuous distraction of the inverted nipples; and sustaining 3 to 6 months. From August 2002 to December 2003, 14 patients (26 nipples) were treated. 12 patients had bilateral inverted nipples. Patient age at operation ranged from 14 to 40 years (mean age, 24 years). All nipples were congenital, and they had no previous operation. Six nipples were grade I, 9 nipples were grade II, and 11 nipples were grade III according to the classification of inverted nipple by Han and Hong. The mean follow-up period was 7.3 months (range, 3-12 months). Follow-up examinations revealed no evidence of recurrence of inversion. There was no complication associated with surgery, such as infection, hematoma, permanent sensory disturbance, or nipple necrosis. All patients were satisfied with their results. The authors conclude that their procedure is reliable, a simple, safe, and effective method for correction inverted nipple. But a long-term follow-up is needed. This technique can be applied to any type of inverted nipple as a primary surgical procedure.

The Effect of Continuous Elastic Outside Distraction on the Expressions of Vascular Endothelial Cell Growth Factor and Microvessel Density in Female Porcine Nipple

“…Furthermore, it allows granulation tissue to grow and support the nipple with minimal injury to the nipple-areola complex. Although we accomplished this with positive results, we were unable to obtain histological evidence from the treated patients [11]. Therefore, we adopted the porcine model.…”

“…It is simple, reliable, quick, and has a low rate of recurrence with no visible scarring. The technique does not require special or bulky dressing and it preserves ductal function [11]. However, the mechanism of correcting inverted nipple remains unclear.…”

Correction of Inverted Nipple with “Arabesque”-Shape Sutures

“…Together with a concern that the purse-string method may affect the blood supply to the nipple, a new group of techniques has emerged aimed at supplementing soft tissue bulk beneath the nipple. Over the years, a number of different methods have been used including dermoglandular flaps, auricular cartilage, and alloplastic material such as synthetic supports to nipple piercing [4][5][6][7][8][9][10].…”

“…Many different surgical techniques to correct inverted nipple have been described such as dermal and dermoglandular flaps, endoscopic release, internal suture, continuous traction, and artificial dermis, suggesting that no technique is totally successful [4][5][6][7][8][9][10]. The diversity of procedures denotes the lack of a single technique that reliably results in durable, sustainable correction for this common problem.…”

Inverted Nipple Correction Using a Combination of the Perpendicular Suture Method and the Purse-String Suture Method

“…Surgical techniques to correct inverted nipples have been studied, and various methods have been suggested, such as dermal and dermoglandular flaps, endoscopic release, internal suturing, continuous traction, and the use of artificial dermis [3][4][5][6][7][8]10]. Techniques using sutures have the advantage of reducing incisions and scarring, and are also considered safe.…”