Introduction.

Nipples for both men and women may vary in shape and size from flat, to pointed, to having one or two “lobes” at the tip, to bumpy, to looking like a dimple, or to being a total “innie”. The majority of nipples do stick out a bit, from 5- 10mm, however all of the above variations are normal and common.

Grade 1

Nipple inversion is classified into three groups; Grade one, is where the nipple can be pulled inwards, but at other times protrude. A “shy” nipple can point out in cold temperatures such as cold water, or can be brought out with some massage or stimulation.

Grade 2

Grade two nipples are where the nipple natural inverts however can be pulled outwards leading to the nipple stretch, allowing it to sit in an everted position and appear to stick out. Once released the nipple will gradually sink back into an inverted position.

Grade 3

True inverted nipples are present from birth, and do not protrude with cold or stimulation. These nipples are so inverted to the underlying breast tissue that they cannot be pulled outwards. The cause is usually from connections in underlying tissue, ligaments and the skin. Ligaments along the milk ducts, which connect to the nipples, are shorter and pull the nipple in towards the breast tissue.

If nipples seem inverted later in life, or after breastfeeding, the cause can be that the skin of the breast can become looser and relax around the nipples making the nipples to appear to be inverted. However, if a nipple has not always been inverted and suddenly does so, it is important to see your doctor right away to determine if there is some other medical cause.

Having one or both nipples not prominent can be the cause of self-consciousness, and women in the childbearing age group may worry about potential problems with breastfeeding.

Technique:

I perform correction of inverted nipples under local anaesthetic as a day case. It takes approximately 15-30 minutes.

A small cut ‘incision’ is made into the areole. The fibrous tissue between nipple and the underlying tissue is released either by ‘stretching or by ‘cutting’. A special stitch is used to keep the ‘released’ and the everted nipple into its position. I use dissolvable sutures hence they do not require removal of stitches

Sutures are applied within to hold and support the nipple in the corrected position. The sutures will slowly dissolve around a 2 week period.

Risks and complications:

There are risks of surgical correction of inverted nipples as with any surgical procedure. These include scarring, bleeding, infection, pigmentation of the scar, altered sensations, under or overcorrection, asymmetry and a small possibility of revisional procedure. The procedure of correction of inverted nipples is relatively a safe and simple procedure with small possibilities of the above described complications.

Summary

Correction of inverted nipples is a relatively simple and safe procedure with satisfactory results done under local anaesthetic within a minor procedure unit as a day case.