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cosmetic surgery - nipple eversion

nipple eversion

Nipple inversion or retraction is most often a congenital condition, but inversion may also be caused by cancer, operations, trauma or infection (most commonly periductal mastitis). Sometimes the condition seems to have a hereditary background.

Symptoms:
Feeding problems. The infant cannot grasp the inverted nipple. Occasionally it may be pulled out manually.

Hygienic problems. Infections may occur as it is difficult to establish proper hygiene.

Cosmetic problems. For many women the condition may be cosmetically disturbing and present a psychological handicap.

Before surgery:
Since inversion of the nipple might be a symptom of carcinoma of the breast, a careful history must be taken and investigations such as mammography and ultrasound must be performed to exclude this condition.

Surgery:
The objective of surgery is to reshape the nipple and areola so the nipple projects from the breast, enhancing appearance while preserving sensitivity.
There are two types of surgery:

The milk ducts remain intact, trying to presere the ability to breast feed.

The milk ducts are cut in order to get a proper surgical access.

Surgery may be carried out under local anaesthetic and sedation. An incision is made at the base of (or around) the areola and in the first instance the nipple and areola tissue are lifted (but still connected to) the breast and stitched into a new projecting shape by using a ‘purse string’ style suture. Because of the shape of the incision around the nipple, scar contracture will increase nipple projection.

Repair with detachment of the milk ducts tends to be more common and may be necessary in more difficult cases. With this surgery the incision is the same but the shortened milk ducts are detached, allowing natural looking projection.
Surgery time is depending on the technique used and individual anatomy. This is a day case procedure, overnight stay is not required.

After the operation:
You will experience some mild pain and some swelling for the first two to three days. The pain is well controlled by prescribed medication and the swelling will decrease over the next three weeks. There will be some mild bruising. You may return to work after a few days unless you have a physically demanding job. If this is the case you will need to limit yourself to light duties for up to two weeks ie no heavy lifting.

Long term outcome and risks:
The surgical procedures mentioned will produce permanent nipple projection, nipple sensation is almost always unchanged and there is minimal scaring due to a circumaerola (around the nipple) incision.

Infection and bleeding rarely occur and are a risk factor of any surgery.

A change in nipple sensation has been reported in a small number of cases.

The ability to breast feed cannot be guaranteed.

The final surgical result may be unsatisfactory, the inversion may recur and a corrective procedure may be necessary.