VIP International Plastic Surgery Center in KOREA - Inverted Nipple

Inverted Nipple Correction

An inverted nipple is when the nipple is retracted into the breast instead of pointing outward. It occurs because the fibrous band beneath the nipple continues to pull the nipple, and the tissue supporting the nipple is insufficient. An inverted nipple causes not only an aesthetic problem, but may also hinder the ability to breastfeed, leading to breast cancer in severe cases. Both women and men can have inverted nipples.

It is congenital and may recur even after surgery.

The method to correct inverted nipple is to cut the fibrous band and support a stout structure beneath the nipple. The inverted nipple is drawn outward through an incision around the areola and suture in various ways to prevent recurrence.

An inverted nipple is not protruded compared to the surrounding tissues and is flat and dented, whereas an ideal nipple points outward in appropriate size and height in Ω shape.

Causes of Inverted Nipple

The causes are classified mainly as congenital and acquired, and in most cases it is congenital and bilateral. When acquired, it can occur by wound, aftereffect of breast cancer or complications after macromastia surgery.

If due to congenital cause, a mammary gland is formed in the ectoderm during the sixth to seventh week of fetal life, this mammary gland grows in the mesenchymal tissue and forms a lactiferous duct. During the final stage of fetal life, a nipple is formed by protuberance due to the proliferation of mesenchymal tissue. When the lactiferous duct is short due to undergrowth or the proliferation of mesenchymal tissue, an inverted nipple is formed. Thus, it occurs due to the decreased amount of connective tissues in the inverted nipple.

Classification of Inverted nipple

It is classified clinically into two categories: concave and invaginated.

Concave nipple, The level of inversion is mild and naturally curable, which can be protruded by stimulation or suction. In such case, a continuous physical treatment, such as continuous suction, is recommended more than surgical correction. It can also be naturally corrected through breastfeeding.

Invaginated nipple, The level of inversion is severe and naturally incurable, which cannot be protruded by any stimulation. It not only looks aesthetically unpleasant but also disables breastfeeding, and inflammation may occur often. The base of inverted nipple is wide, the skin of areola is not enough and the nipple part is overall flat or rather dented.

In such case, a surgical correction is necessary because the nipple cannot be protruded without cutting some lactiferous duct or fibrous cord due to short lactiferous duct or a lot of fibrous cords.

Surgical method

The objective of the surgery is to restore normality in function, shape, sensing and more. However, based on the level of severity, it may be difficult to achieve all. As for the correction, the short lactiferous duct should be lengthened, the fibrous tissue (which restricts the protrusion of the nipple) should be cut and the insufficient tissue beneath the nipple should be supplemented.

Areola Reduction

Nipple hypertrophy is more common in Asians than in Caucasians. It not only looks aesthetically unpleasant but also causes problems in breastfeeding.

The symptom occurs generally during pregnancy, childbirth and lactation, but may also occur in young women who have unusually big nipples, requiring a surgery.

For Korean women, the average nipple size is under 1 cm in diameter and 7-9 mm in height. The size is not important, but should be in relative size to the shape and size of the breast, forming a balance. An excessively big nipple breaks the harmonious balance of the overall breast shape and may appear saggy. Therefore, in such case, areola reduction is necessary to reshape the nipple in appropriate size.

Surgical method

Among various areola reduction methods, the most appropriate method should be opted to minimize scar and effectively reduce the areola.

The basic principle is to incise a part of nipple skin in the center and suture it. In case of a large nipple, the upper part of the nipple is excised, and the rest remains in appropriate size and then sutured. Regardless of the method, scars are inconspicuous and a satisfactory result can be obtained.