The most common concern in women regarding their nipple characteristics is the inverted nipple.
In most severe cases, recurrent infections, inflammation and difficulty or impossibility of breastfeeding is noted. It is felt that the most common cause of inverted nipple is the lack of bulk in the connective tissue that normally prevents the nipple from being retracted by muscle and connective tissue fibres that are associated with glandular milk ducts of the breast tissue. This can also be associated with shortened breast ducts.
There are different severities of inverted nipple with the mildest form present when the inverted nipple can be easily pulled out and maintain its projection quite well without retraction, and the most severe case where it is very difficult to manually pull it out.
The main methods of inverted nipple correction are classified into three groups: the first method proposes to create tightness at the neck of the inverted nipple, the second is designed to add bulk beneath the nipple after cutting its ductal system, and the third method uses duct-saving, partial areolar and nipple muscle excision and reconstruction using buried sutures.
Recent advances focus on minimally invasive procedures where the ducts and the nerves are maximally preserved allowing for normal function and breastfeeding following the correction.
Nipple inversion in women are significant aesthetic concerns. Although most of the corrective surgeries are performed by plastic surgeons, more and more dermatologic surgeons are asked to assist in this common problem.
Do go for several consultations before deciding on a surgery.
Article written by Mariusz J.A. Sapijaszko, MD FRCPC (Dermatology)
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