Inverted Nipples or Nipple Inversion

Sometimes the breasts do not develop properly and you end up having nipples that are inverted or have caved into the breast. This condition affects some women, who of course would rather not have it.

The nipples tend to retract or invert. The nipples can form a slit or depression when retracted. Such problems come in different degrees of nipple inversion. In the milder forms, manual manipulation can make the nipple come out. In the more severe forms, the nipple cannot be everted.

For many women, having inverted nipples can be distressing. Nipples lying flat against the breast or actually pulling in from the breast surface can be a source of self-consciousness and breastfeeding problems.

Inversion of the nipple is caused by a short milk duct system running from the chest wall to the nipple.

Women with inverted nipples basically have a choice of two types of surgical treatments - surgical (with small scars) or surgical (with no scars).

Dr. Speron has been resculpting nipples for many years.

The best candidates for correction of inverted nipples or nipple inversion

  • 18 years of age or older
  • Not currently pregnant or nursing
  • In good physical health
  • Psychologically stable
  • Realistic in their expectations
  • Having this surgery for the first time
  • All surgery carries some uncertainty and risk
    When correction of inverted nipples is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, as with any surgery, there are risks. These include re-inversion, infection, bleeding, skin injury, adverse reaction to anesthesia, noticeable scars, permanent pigment changes, or slightly mismatched nipples. The procedure may also result in noticeable scars, permanent pigment changes in the breast area, or slightly mismatched breasts or nipples. Nipple protrusion with stimulation may change. If nipple inversion recurs or asymmetry is significant, a second procedure may be needed.

    The temporary effects of inverted nipple surgery include loss of breast sensation or numbness, which may last up to a year.

    The ability to breast feed after any surgery for inverted nipples cannot be guaranteed!

    Planning your inverted nipple correction surgery
    The initial consultation with Dr. Speron is very important. He will need a complete medical history, so check your own records ahead of time and be ready to provide this information. First, Dr. Speron will examine your breasts and check for the extent of the nipple inversion.

    Dr. Speron may also recommend a mammogram, or breast x-ray. This will not only rule out the very small possibility of breast cancer, but will reveal the breast's composition and degree of scar tissue. Once he knows how severe the nipple retraction is, he can then choose a surgical approach to best suit your needs.

    Don't hesitate to ask Dr. Speron any questions you may have during the initial consultation for inverted nipples- including your concerns about the recommended treatment or the costs involved. Treatment of inverted nipples may be covered by medical insurance--but policies vary greatly. Check your policy or call your carrier to be sure. If you are covered, make certain you get written pre-authorization for the treatment recommended by your surgeon.

    Preparing for your surgery
    Dr. Speron will give you specific instructions on how to prepare for surgery, including guidelines on eating, drinking, and taking certain vitamins and medications.

    Smokers should plan to stop smoking for a minimum of three weeks before surgery and during recovery. Smoking decreases circulation and interferes with proper healing. Therefore, it is essential to follow all your surgeon's instructions.

    Where your surgery will be performed
    Surgery for nipple inversion is most often performed as an office procedure, but in extreme cases, or those where other medical conditions present cause for concern, an outpatient surgery center may be recommended. The surgery itself usually takes about thirty minutes to complete. However, more extensive procedures may take longer.

    Type of anesthesia
    Correction of an inverted nipple may be performed under local anesthesia. You'll be awake, but very relaxed and insensitive to pain. More extensive correction may be performed under sedation, which allows the patient to sleep through the entire operation. Dr. Speron will discuss which option is recommended for you, and why this is the option of choice.

    The surgery
    Surgical techniques used today fall into two categories: those that preserve the milk ducts and those that do not. In either case, the objective is to reshape the nipple and areola so that the nipple projects out from the breast, enhancing the appearance of the breast while preserving sensitivity of the nipple. The technique that leaves the milk ducts intact can also help preserve a woman’s ability to breastfeed.

    1. Inverted nipple repair with partial preservation of milk ducts:

    No Scar Approach
    A needle id used around the base of the nipple on the areola.

    The nipple and areolar tissue are freed and lifted from (but still connected to) the breast and stitched into a new, projecting shape utilizing a “purse-string” style of suturing (stitches). Because of the circular shape of the scar around the nipple, scar contracture will actually increase rather than decrease nipple projection. Dressing is then applied.

    Because some of the milk duct system is still attached to the nipple, breastfeeding is likely but cannot be guaranteed.

    Small Scar Approach
    An incision will be made just around the base of the nipple on the areola.

    The nipple and areolar tissue is lifted from (but still connected to) the breast and stitched into a new, projecting shape utilizing a “purse-string” style of suturing (stitches). Because of the circular shape of the scar around the nipple, scar contracture will actually increase rather than decrease nipple projection. Dressing is then applied to the site.

    Because some of the milk duct system is still attached to the nipple, breastfeeding is likely but cannot be guaranteed.

    2. Inverted nipple repair with detached milk ducts:
    This procedure is more common for severe forms of nipple inversion and may be necessary in secondary cases. An incision is made at the nipple base, and the shortened milk ducts are detached, allowing a natural-looking projection of the nipple. The incision is sutured closed, and dressing is applied.
    You will not be able to breast feed!

    After your nipple inversion surgery
    You will feel some discomfort for a few days after nipple inversion surgery. However, discomfort can be controlled with medications prescribed by your surgeon. In any case, you should arrange to have someone drive you home after surgery and to help you out for a day or two if needed.

    You'll be swollen and bruised for a few days.

    In the meantime, it is important to begin getting back to normal. You'll be encouraged to begin walking around on the day of nipple inversion surgery, and can return to work when you feel well enough--which could be as early as a day or two after surgery. Any stitches will generally be removed about 1 to 2 weeks following the procedure.

    Dr. Speron may advise you to avoid sexual activity for a week or two, and heavy exercise for about three weeks. In general, it will take about a month before you're back to all of your normal activities.

    You should also avoid exposing the resulting scars to the sun for at least six months. Sunlight can permanently affect the skin's pigmentation, causing the scar to turn dark. If sun exposure is unavoidable, use a strong sun block.



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