Sir: The inverted nipple is a common deformity characterized by the relative shortness of the lactiferous ducts, which tether the nipple and prevent it from projecting.1 This condition is combined with resistant collagen fibers and insufficient bulkiness of connective tissue beneath the nipple. It has been recognized since 1849, when Sir Ashley Cooper first made note of it.2 This deformity can be either congenital or acquired. It has been widely described and graded, and it is possible to correct it using a broad variety of surgical techniques in relation to the severity of the inversion presented by the nipple.3,4 Relapse of the inversion is very common and is the most noticeable consequence of correction, when the lactiferous ducts are not exactly divided. For this reason, it is fundamental to stress the importance of follow-up as well as that of the surgical maneuvers chosen to achieve and maintain a lasting result. We used Pitanguy's technique,5 which involves the actual release of the fibrous tissue between the ducts with a direct approach made through a trans–nipple-areola incision, to correct 28 grade II inverted nipples, following the classification proposed by Han and Hong (the nipple can be pulled out, but it cannot maintain the projection and tends to return to its original position). The ducts were dissected free from the surrounding fibrous muscular tissue and released. The tissues were then approximated and sutured using a 3.0 Vicryl suture, the deep layers first, to provide more bulk to the nipple-areola complex. Surgery was performed with the patient under local anesthesia. To prevent relapse of the inversion, we combined this technique with the use of a splint, designed by us and made of Thermoplast, which must be round, without a triangular piece, to allow the edges to overlap (Fig. 1). We formed the device by taking a mold of the nipple after surgical correction. A paraffin gauze pad was interposed to prevent pressure sores from developing on the areola. Using a 16-gauge needle, we made two holes in the device and maintained nipple eversion by suturing the nipple to the splint with a transfixed 4.0 Ethilon suture.Fig. 1.: The round Thermoplast splint after removal of a triangular piece so that the edges could overlap. A 16-gauge needle is used to create two holes in the splint, and the splint is placed on the nipple-areola complex.At first patients had to keep the splint in place for 3 weeks. We then removed the stitch, but patients had to keep the splint in place for an additional 4 weeks, to protect the surgical site beneath the brassiere and to make patients feel safe. After removal of the splint, we found no evidence of nipple necrosis or any kind of skin distress. At the 3-, 6-, and 12-month follow-ups, we found no evidence of relapse. We finally obtained complete symmetry of the nipple-areola complex with no noticeable scars. The splint is very easy and cheap to construct, and it guarantees effective prevention of nipple re-eversion at long-term follow-up (Fig. 2).Fig. 2.: Preoperative and postoperative views of grade II inverted nipple.Caviggioli Fabio, M.D. Ventura Domenico, M.D. Andretto Amodeo Chiara, M.D. Klinger Francesco, M.D. Istituto di Chirurgia Plastica Universita’ degli Studi di Milano Istituto Clinico Humanitas Rozzano, Mi, Italy