Inverted nipples

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Plastic surgery of inverted nipples can be performed by release of shortened ligament structures around the lactiferous ducts or by blockage of lactiferous ducts. It is also good to consider conservative methods before the procedure. The surgery is usually performed under local anesthesia.

Attractive body figure is a dream of every woman. And the female breast crowns the figure shape. It represents dominant secondary sexual sign for the most of public. Beside that it is important for baby nourishment. So it has together with functional role - breastfeeding, also to majority of woman’s life important aesthetic meaning. Moreover in case of nipples it is not a “static” organ but it can change its shape.

The breast shape is so characteristic for female body that it brings hundreds of women to the clinics of plastic surgeons. They are convinced that the look of breasts is a handicap in life and relations. Modifications of size and shape belong to the most frequent procedures in the specialty of plastic cosmetic surgery while modification of the look of areola and nipple is far less so common. This complex plays however irreplaceable role in the above mentioned situations.

Inverted nipple as a congenital defect is solved by plastic cosmetic surgery as a specialty. Situation, when the inverted nipple occurs during woman’s life brings various problems. If the nipple changes its shape from the original posture and function there is needed interdisciplinary care between surgeons, mammography specialists and often oncologists. Gained inverted nipple is very often a symptom of tumor growth inside the breast and its only correction by plastic surgeon would be a wrong step. Female breasts undergo during development many changes. It is quite common that many girls in the age of puberty suffer from the problem of inverted nipples. They can be calmed by the fact that until the breasts are not definitely shaped (approximately at age of 16 to 18 years) this problem will be solved with high probability itself without the need of surgery. Also pregnancy modifies many times the state of inverted nipples.

There are 3 grades of inverted nipples

 

  1. Grade: The nipple can be easily protracted. It comes out itself by massaging of surrounding areola or other stimulation.

  2. Grade: The nipple can be protracted but it moves back quickly. The nipple comes out itself by massaging and stimulation.

  3. Grade: It is very difficult or even impossible to protract the nipple.

Therapy

During the decision making of the process to solve congenital defect it is important beside other aspects, whether the nipple is inverted permanently. Then it very often complicates or even disables breastfeeding. On the other hand the nipple can be protracted by stimulation or breastfeeding.

The choice of therapeutic process is also influenced by the fact if the correction should be made in woman that does not assume breastfeeding or in woman that still expects her pregnancy. At first the surgeons offers one of the three conservative methods to the patient. This treatment takes at least half a year, if the state is not improved it is good to consider the surgery. Some surgeons advise the surgical method from the beginning because the conservative methods of treatment have uncertain and short lasting effect.

Methods

Basically there are 3 principles of surgical treatment. They are chosen depending on the individual situation and patient:

  • Conservative - piercing and massages, breast shells, nipple shields for breastfeeding

  • Surgical - Release of ligament structures along the shortened lactiferous ducts, blockage of lactiferous ducts

Conservative method

  1. Piercing, massages

  2. Breast Shells

  3. Nipple Shields

In some cases the nipples permanently protract after breastfeeding. Sometimes there is used piercing and massages for nipple correction.

Massage: Hoffman technique - exercise that helps to loosen the adhered ligaments. Press gently with two fingers at the edge of areola. Spread the fingers slowly into width. Repeat the massage five times a day.

Piercing is frequent method in lighter grades of inverted nipples. Sometimes the effect of surgery is at the end fixed with piercing. Piercing is performed in all clinics out - patiently under local anesthesia.

Breast Shells: Many experienced surgeons recommend as a method of first choice so - called breast shells. Those are transparent discs similar to breast nipple. It is fixed to the breast in the place of nipple and the patient sucks gradually the air from the shell with a pump. There creates underpressure that is managed by the patient. This method is based on permanent protracting of shortened ligaments and lactiferous duct. The therapy is painless and discrete. The shell can be easily hidden in the bra. It is necessary to wear it at least eight hours a day and it is not bad to wear it even longer. The treatment should take a least 3 to 6 months. If the problem does not get better you will probably not avoid surgical procedure. During pregnancy the breasts become more sensitive, if it is comfortable you can wear the shell even during pregnancy. If permanent wear of the shell causes problems for you during pregnancy it is used right before breastfeeding. The nipple protracts and the baby is able to suck. The shells are sold under the brand Niplette, Medela, Avent, Chicco - corrector of breast nipples, Farlin - breast shells. When using it is necessary to control the skin of the nipple.

Nipple Shields: It is a device for breastfeeding. It is made for women with flattened or inverted nipples when their baby cannot suck. The shape is similar to normal nipple and it stimulates the baby to latch on. It is made of silicone latex or plastics. The shape is similar to a cap that copies the areola and it protracts in the middle as an imitation to drawn out nipple. There is a small hole inside it. It is there for the baby to suck. Mother must keep higher hygienic standard because the bacteria might reproduce faster under the shield. Drug stores sell this device in wide rage of different brands. Baby - nova, Bocek, Mam car, NUK - ortodont, Farlin KaWeCo - nipple shields.

Breast shells and nipple shields are produced as single - use devices although it is also possible to buy it as a device with possible home sterilization and subsequent further use.

Surgical procedure

  1. Release of shortened ligament structures

  2. Blockage of lactiferous ducts

Release of shortened ligament structures

In young women the surgeon chooses procedure when the lactiferous gland are not damaged and here the future breastfeeding is not disrupted. The procedure is then based on release of shortened ligament structures alongside the lactiferous ducts.

The ligament on the circuit of nipple is released from several radial rhombs on the edge of areola and nipple. Subsequently is the position of nipple fixed by lateral suture of removed parts from the areola.

The patients wear special bandage for several days after the surgery. The procedures are normally performed under local anesthesia. Depending on the chosen procedure there remain several in general inconspicuous radial scars on the areola and nipple. In relatively great percentage of procedures is the result unsatisfactory.

Blockage of lactiferous duct

In patients when we do not expect further breastfeeding it is possible to block the lactiferous ducts during the surgery. These surgeries are also mostly performed under local anesthesia. The surgeon then releases from two tiny cuts the shortened structures in the base of nipple. The new position of nipples is fixed with silicone drain, which remains there for approximately 2 weeks.

Another procedure is nipple split, blockage of the structures and use of several flaps to fill the base of nipple. The scars stay either right on the nipple or in its near surrounding. The care after the surgery is similar with above mentioned procedures. The results are in these cases more satisfactory than in already mentioned procedures.

Anesthesia

The procedures are normally performed under local anesthesia. It is in general not a difficult surgery but some patients that fear from pain require general anesthesia. It causes more costs and one day stay in the hospital after the surgery.

Complications

Complications by this surgery are very rare. The main problem is re - invertion of the nipple, swelling, bleeding and infection. Undesirable is also nipple asymmetry and complication with the scar such as keloid scars (scars with excessive ligament) and increased pigmentation. The nipples can be insensitive after the surgery. This feeling should fade away in 3 to 7 days. The surgery can become more complicated and the insensitiveness can remain.

Financing

The devices for breastfeeding and breast shells: 200 - 1500 CZK. The surgery is not covered by health insurance. The prices at different clinics vary. For orientation look at the section price list. (Price list)

Results

By conservative procedures the result is uncertain and also not permanent. The most permanent effects from conservative methods are reached by piercing. From surgical procedures the best and most permanent results are by the surgery of lactiferous ducts blockage.

 

Updated: 2009-04-20

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