An integrated approach to the repair of inverted nipples

Abstract

Background Many methods for the correction of the inverted nipple have been described, but no consensus has been reached as to which is the best approach. Objective We describe an integrated approach to the correction of nipple inversion that minimizes ductal disruption. Methods We performed initial nipple eversion using gentle traction with a skin hook. The nipple base was approached with the use of an inferior periareolar incision through the subcutaneous tissue. Blunt dissection parallel to the ducts restored varying degrees of projection. Selective ductal division was performed as necessary to obtain complete eversion with normal projection. To maintain the nipple in an overcorrected position, we placed a nylon traction suture through the center of the nipple and affixed to a stent consisting of a medicine cup and gauze padding. Results In a series of 21 patients, nipple eversion was maintained after at least 1 year's follow-up. Conclusions The technique for correction of nipple inversion reported here is focused on blunt dissection through vertical spreading parallel to the lactiferous ducts, with selective division of only those ducts that restrict nipple projection. The use of traction stenting helps ensure eversion and protects the repair. The technique produces excellent results without recurrence of nipple inversion.