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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

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