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Archive for the ‘nipple enlargement’ Category

The Inverted Nipple – Classification and Treatment

Sunday, July 22nd, 2012

An inverted nipple (also known as an invaginated nipple) is an aesthetic condition where the nipple, instead of pointing outward, is retracted into the breast. In some cases, the nipple will be temporarily protruded if stimulated, but in others, the inversion remains regardless of stimulus or pull. Inverted nipples are not gender specific and can occur in both women and men. They probably occur more frequently in women due to lactation and breast feeding that can cause ductal scarring and contraction.

The amount of nipple inversion varies and actually has a grading system to define them. It based on how easily the inversion can be brought out or reversed. The grades reflect the amount of scarring/fibrosis that is pulling the nipple inward and there are three grades of nipple inversion.

Grade 1 nipple inversion can easily be pulled or pushed out and does not immediately retract back in. Patients may describe them as occasionally popping out on their own without any effort to do so. This indicates that there is no significant amount of fibrosis or ductal scarring. A Grade 2 nipple inversion can still be pulled out but not as easily as the Grade 1. It differs because it will immediately pull back in, indicating some degree of fibrosis. It never spontaneously pops out on its own. This is probably the most common type of nipple inversion. Grade 3 is the most severe form and can not be pulled out on its own. It is truly stuck down due to fibrosis and also indicates the underlying soft tissue deficiency and ductal deformity. This degree of inverted nipples is associated with an inability to breastfeed and even chronic infections.

Understanding the grade of nipple inversion determines the surgical procedure to correct it. Grade 1 nipple inversions rarely present for treatment as they are partially self-correcting and not that aesthetically distracting. But when they do a simple technique of fat injections into the base of the nipple can work quite well. One can also use synthetic fillers, such as Restylane or Juvederm, but fat injections provide a more assured long-term correction. One to two ccs of fat per nipple is all that is needed.

Grade 2 nipple inversions can be corrected by any of the well described nipple inversion techniques that use an incisional release and internal suturing. Because of the soft tissue defect created as the nipple is released and brought out, it seems more logical to fill this defect with a tissue graft and then suture over it. This will prevent the risk of secondary scar contracture. I have used diced Alloderm (allogeneic dermis) or small fat globules successfully. But when it comes to Grade 3 nipple inversions, it is best to think of a small dermal-fat graft if the patient has an acceptable donor site and will allow it. Otherwise, rolled cadaveric dermis from a variety of manufacturers can be used for insertion into the underlying soft tissue defect.

Dr. Barry Eppley

Indianapolis, Indiana  

Nipple Reduction and Inverted Nipple Repairs

Saturday, April 25th, 2009

Nipples are as variable as the size and shape of breasts. No two nipples are ever exactly alike, usually not even on the same person. While much breast reshaping (breast augmentation, breast reduction, breast lift) goes on in plastic surgery, many men and women suffer from nipple deformities as well which also affects their self-esteem. Nipples can stick out too much, can be turned in, or the areola (the colored area surrounding the nipple) can be too large. Some of these nipple problems may affect certain breast functions such as feeling or lactation. The good news is that there are some very simple plastic surgery procedures that are quite effective at improving these problems.

For the sake of clarification, what most call the nipple is actually two different structures. The true nipple is the central projecting skin area that has both enhanced sensation and milk ducts for lactation. The flatter, almost always more pigmented, skin around the true nipple is called the areola. 

Nipple inversion  (shy nipple) affects about 2% of the population, more commonly in women than men. Some nipples can be turned in slightly or to a significant degree. Some people are born with nipple inversion, others occur later often after breastfeeding. In rare instances, a tumor may be pulling the nipple inward and this should be ruled out particularly if it occurs later in life and just on one breast. Correction involves a simple procedure done under local anesthesia. The nipple is released and brought out. The biggest problem with nipple inversion correction is relapse, the nipple losing projection and returning to an inward position. Nipple inversion surgery can also be done at the time of other breast surgery. I usually like to delay repair in the case of breast augmentation until later as the implant may help to push out some nipples, making correction unnecessary.

Enlarged nipples often create visible ‘headlights’ which can be a source of embarrassment for many women. This can also be an issue for some men. An overly projecting nipple can be easily reduced through a wedge excision or a ‘ring’ reduction approach. Sensation and the ability for milk production can be preserved with either technique. Done under local anesthesia, nipple reductions are very stable and are not associated with any significant relapse.

“Puffy” nipples can occur in women and are usually associated with the tubular breast deformity. In this nipple problem, the areola and the nipple are pushed outward due to an underlying herniation or protrusion of breast tissue. Correction of this problem is slightly more complex than isolated nipple surgery.  It is usually treated as part of tubular breast surgery which involves the use of a breast implant and areolar manipulation. This is treated by making an incision around the areola, removing some of the pigmented skin (if needed), and lifting the areola skin up and decreasing the projection (puffiness). This is a more extensive surgery and requires an operative room experience under anesthesia.

Large or wide areolas are extremely common in big breasts. Usually the size of the areola is related to the size of the breast, but not always. Large areolas are commonly reduced as part of breast reduction surgery. They can be reduced independent of a breast reduction through the periareolar approach. By removing a ring of the outer areola, the circular diameter of the areola is narrowed. Due the tightness of breast skin, there is a limit as to how much the areola can be reduced. This procedure results in a scar at the junction of the areola and skin which occasionally widens and requires secondary revisional surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Different and Unusual Procedures in Plastic Surgery

Thursday, July 3rd, 2008

As plastic surgery has worked its way into the mainstream of American society, it is no surprise that procedures are being done today that were not imaginable a mere ten years ago. And I am not referring here to surgery wonders of technology and scientific advancement (although that exists also), I am talking about what patients desire to have done. This is a reflection and commentary on contemporary American culture, not necessarily how far the science of plastic surgery has come.
As I talk with friends and colleagues about some of the plastic surgery procedures that I do today, I have come to realize that some of them may be considered ‘unusual’ . Certainly, some of them are different than traditional perceptions of plastic surgery. Many are relatively minor procedures that can be performed in the office and probably reflect the trend toward treating smaller concerns. They are the opposite of bariatric plastic surgery, for example, where a new subspecialty of plastic surgery has developed to treat the sequelae of gastric bypass and massive weight loss patients. The emergence of larger plastic surgeries and big procedures doesn’t occur very often but every few decades. But the emergence of more minor plastic surgery procedures occurs much more frequently. Here is a list of my unusual plastic surgery procedures that have emerged and become popular in the past decade.
Buttock Implants/Fat Injections – The appeal of a larger, more rounded buttocks is certainly a body image of recent note. Whether done by transferring fat from one body part to another or by an implant placed through an incision near the tailbone, the desire for buttock enhancement could not have been envisioned ten or twenty years ago. There is actually a great number of patients who would like buttock reduction but no single good procedure exists for that problem.
Labial Reduction – Whether due to discomfort from rubbing on clothes or during inetrcourse or simply to ‘look better’, reducing the size of a woman’s labia is now a common procedure. One would never have thought that such a concealed part of the anatomy would create a demand for treatment. A very simple and effective procedure, labial reduction restores the outer appearance of the vagina to a more youthful appearance.
Earlobe Reduction/Enhancement – As woman age and with the lifelong use of ear rings, the ear lobes will frequently get longer. The size of the ear lobe can easily be reduced (earlobe reduction) in the office and it is a procedure that I often do at the same time of a facelift. Aging may also make one’s earlobes get quite thin and almost shriveled in appearance in very thin females. Injectable fillers, such as Juvaderm or Radiesse, can give an immediate rejuvenation effect to the earlobes that may last as long as a year.
Eyebrow/Eyelash Hair Transplants – The science of hair transplantation has evolved to the point that single hair (follicle) transplants are now routinuely done in scalp hair restoration. It is quite logical that single follicular transplantation be applied to very small areas such as the eyebrow and even the eye lashes. The alternatives of permanent makeup, colored pencils, and false eyelashes made opting for actual hair tranplants a difficult decision. But some few patients do.
Umbilicoplasty – While every full tummy tuck patient gets a new bellybutton (umbilicus), some non-tummy tuck patients want one also. Most commonly, it is to change an outie to an inne belly button.
Nipple Reduction/Nipple Enlargement – I have seen it both ways. The concern of large nipples is that they can be very visible through clothes…and at all times. Reducing the size of the nipple is a simple procedure and some women may lose a little sensation. Most recently, I have started to some men that want their nipples reduced also! Conversely, nipple enlargement or enhancement is about changing an inverted nippled (which is turned inward) to one that has some outward projection. While not quite as predictable (long-term result) as nipple reduction, the nipple can be released and brought more outward.
Corner of Mouth Lift – The downturning of the corners of one’s mouth with age gives a sad or angry appearance. A simple procedure in which a small amount of skin is removed and the corners lifted up and the mouth line leveled gives a nice and subtle improvement. Such a procedure is a simple office operation or is often done as part of a facelift. This is actually an old procedure that has now been ‘reinvented’ or rediscovered.

One wonders what this list will be in another ten years!

Dr. Barry Eppley

Indianapolis, Indiana

Inverted Breast Nipple Correction

Tuesday, November 6th, 2007

The Inverted Nipple – An Innie When You Want An Outie


 Inverted nipples (the nipple is turned inward, often below the plane of the surrounding areola) is a not uncommon problem. The goal of inverted nipple correction is satisfactory aesthetic projection, preservation of the lactiferous ducts, as well as maximizing nipple sensation (sexual pleasure). Correction of inverted nipples is a simple office procedure done under local anesthesia. The single greatest problem with its correction is long-term prolapse due to scar contracture, with an eventual return to its original inverted position.

Many surgical techniques have been described for this relatively simple procedure. Most of these start with a release of the nipple by making small incisions at the base of the nipple, cutting the deeper lactiferous ducts, and then providing tissue support by using small flaps of areolar tissue to support the raised nipple. There is no postoperative pain and the patient may shower the next day with no concern about getting the nipple wet during showering. All sutures are dissolvable.

I have improved the long-term results of this procedure by changing the standard way the procedure is done. By doing less release of the deeper ducts (with decreased risk of loss of nipple sensation) and using pull-through areolar flaps (which act as a hammock), nipple projection is better supported long-term with less risk of complete inversion. An alternative approach is to place fat or dermal grafts underneath which is also a good option to fill the dead space and give the nipple less ‘room’ to fall back or scar into.

Dr Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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