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Inverted nipple repair technique demonstrates positive outcomes over 7 years

An integrated approach to correcting inverted nipples was found to minimize ductal disruption safely and effectively during the course of a 7-year period, according to researchers.

The researchers performed a retrospective chart review for 103 patients, including one male, who underwent correction of nipple inversion. The review included 191 nipple corrections, with nine patients having undergone previous nipple-correction surgery. The researchers documented complication rates, breastfeeding status and patient demographics.

First, surgeons used gentle traction with a single skin hook to achieve nipple eversion. The nipple base was freed through an inferior incision at the nipple base. Then, fibrous bands that constricted the base of the nipple were freed using blunt dissection and a vertical spreading technique parallel to the ducts, which restored nipple projection, according to the researchers. Next, two external horizontal mattress sutures were placed — one from 12 o’clock to 6 o’clock, and the other from the 3 o’clock to 9 o’clock position. An external 4-0 chromic purse-string suture was placed at the junction of the nipple and areola, providing stability. Finally, a 4-0 nylon traction suture was placed through the point of highest projection of the nipple and affixed to a stent comprising a medicine cup and gauze padding, which was maintained for 2 to 5 days.

Results showed 12.6% of patients experienced recurrence, and three patients had bilateral reoccurrence. Other complications were few and included partial nipple necrosis (1.05%), breast cellulitis (1.57%) and delayed healing (0.5%), according to the researchers.

Overall complication rate was 15.74%, and approximately 19% of patients experienced at least one complication. Reoccurrence was the most common complication, according to the researchers.

The researchers noted that very few referrals for this corrective surgery came from primary care physicians or obstetric-gynecologic physicians, despite the fact that patients reportedly addressed their concerns to these practitioners.

Patients’ mean BMI was 21, and median bra cup size was B. The researchers suggested the higher rate of reoccurrence in this study could be attributed to the differences in duration of nipple retractor and/or differences in patient demographics like BMI. – by Abigail Sutton

Disclosures: Gould reports no potential conflicts of interest with respect to the research, authorship and publication of this article. Please see the full study for a list of all other authors’ relevant financial disclosures.