Correction of Inverted Nipples a New Method Using Bilateral Rhomboid Nipple-Areolar Deepithelialized Turn-Over Flaps

Abstract

Inverted nipple has been recognized for more than 165 years and it has negative aesthetic, hygienic and functional consequences for both genders. An inverted nipple is defined as one located on a plane lower than the areola. Multiple factors may cause inverted nipple. Nipple inversion can be congenital or acquired. According to a recent classification proposed by Han and Hong, this deformity may be divided into three grades depending on severity. Various corrective surgical and non-surgical techniques have been described. We try to cluster these procedures into three groups. The first group provides traction, the second creates a tighter nipple neck, and the third adds bulk to the side of the base of nipple and beneath the nipple. A review of the literature revealed that the idea of ”triangular flap,” first proposed by Elasy in 1976, has been modified by many authors. The ”triangular flap” technique had the advantage of providing both the tighter neck and greater bulk needed to correct grade Ⅱand Ⅲ inverted nipples. We created a new and successful modification of this surgical procedure. From January 2001 to August 2004, a total of 23 grade Ⅲ inverted nipples in 12 patients (11 females and 1 male; mean age, 32 years; range, 20-45) were corrected using this new procedure. The post-operative follow-up period ranged from 6 months to 49 months (average 23.6 months). There were no complications related to the operation. All patients were satisfied with the surgical results (i.e., anatomically correct nipple projection), and nipple projection in all cases was maintained up to the latest follow up. The procedure is simple, reliable, and can be applied to any grade of inverted nipple with excellent results.