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Objective:To discuss the procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved.Methods:A total of 35 patients (63 sides) with primary inverted nipples from January 2006 to March 2019 were reviewed retrospectively. Tiny radial incisions were made on the areola around the base of the inverted nipple which had been pulled out. Without skin removed, shorten fiber bundles which caused nipple inverted were totally cut and released. While the primary breast ducts were preserved, purse-string suture was taken around the base of the nipple. The nipple protector was prepared by ourselves, and the nipple was pulled and suspended for 2-6 months.Results:Sixty-three sides of 35 patients with inverted nipples were successfully corrected by this minimally invasive surgery. There was no nipple necrosis. One patient developed mild swelling 3 weeks after operation, and the swelling subsided after symptomatic anti-inflammatory treatment. The average follow-up period was 39 months. After removing the nipple protector, 2 sides (2/63) had a certain degree of recurrence. The rest of the nipples had ideal shape, no obvious scar, good nipple feeling, and retained the possibility of lactation.Conclusions:The procedure for correction of inverted nipple using tiny incision with primary breast ducts reserved has advantages of minimal invasion, safety, less pain, while retaining the possibility of lactation in the future. The clinical effect is satisfactory. It is especially suitable for the correction of type Ⅰ and type Ⅱ inverted nipples.
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Objective:Nipple inversion is relatively common, occurring in up to 10% of females, various techniques have been described for correction of inverted nipples. However, data are limited on the associated complications. The presented study aimed to assess the management of nipple necrosis after inverted nipple repair.Methods:A retrospective chart review was performed on 25 cases of nipple necrosis after correction of nipple inversion between January 2018 and June 2020. All patients were female. Age ranged from 10 to 37 years with the average of 24.4 years. 13 cases were partial nipple necrosis with retract recurrence, and 12 cases were complete nipple necrosis.Results:The follow-up period was 6 months. All cases achieved primary healing. No infection or nipple necrosis occurred. All patients had satisfactory appearance.Conclusions:Appropriate intervention time, accurate preoperative evaluation and well-performed operation are important factors for the management of nipple necrosis after inverted nipple repair.
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Objective@#To investigate the clinical application and efficacy of treatment in inverted nipple with a kind of lactation function preserved method of minimally invasive surgery.@*Methods@#96 patients with type Ⅱ and type Ⅲ inverted nipple admitted by our hospital from January 2013 to December 2017 were selected for treatment by modified self-made nipple orthotic device. Following up 7 months to 5 years to observe the effect of nipple correction and lactation function.@*Results@#87 cases of the patients received satisfactory therapeutic effect, and the lactation function was not affected; 2 cases of type Ⅱ and 3 cases of type Ⅲ inverted nipple were evaluated as medium, with mild nipple retraction; 4 cases were worn for less than 1 month, and the outcome was poor.@*Conclusions@#The modified nipple orthotic device is suitable for type Ⅱ and Ⅲ patients with inverted nipple, which is simple and effective method in nipple inversion.
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Objective To investigate the clinical effect of type A botulinum toxin and nipple retractor in correcting severe inverted nipples.Methods All the patients with bilateral severe inverted nipples that sought consulting in the Plastic and Reconstructive Surgery Center of Peking Union Medical College Hospital were included in this study and the patients were randomized into different treatment group with nipple retractor only or BTX-A (Lanzhou,China) combined with nipple retractor.In the combined therapy group,50 u BTX-A was injected into the bottom of each nipple.2 weeks later,nipple retractor was placed and kept wearing for 6 months.For the retractor only group,no BTX-A was used.All the patients were followed up at 1 month,3 months and 6 months after the operation.Nipple projection was measured according to the profile view of pre-and post-operation.Effectiveness and complication rate were compared between the two groups.Results 20 patients were included in this study.Average nipple projection in the combined therapy group was (1.12±0.13) cm,(0.95± 0.10) cm and (0.73±0.11) cm (3 months,6 months and 12 months post-operation,respectively),which had a significant difference from that of the retractor group [(0.81±0.10) cm,(0.72±0.12) cm and (0.53±0.10) cm].Total complication rate of combined group was also lower than that of retractor group.The complications of the combined therapy group included hypopigmentation (1 case),without skin ulcer or wire dislocation.However in the retractor group,complications included skin ulcer (2 cases),hypopigmentation (1 case) and dislocation (1 case).No severe complications such as nipple necrosis happened in both groups.Conclusions BTX-A combined with nipple retractor is an effective method in correcting severe inverted nipple with low complication rate.
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Objective:To evaluate the effect of the PolinGer rehabilitation instrument with nipple aspirator and manual milking treatment to promote the primipara with inverted nipple successful breast-feeding.Methods:84 cases of inverted nipples of primipara were randomly divided into the observation group and the control group, 42 cases in each group. The observation group used PolinGer rehabilitation therapy apparatus treatment with nipple suction device and manual milking and the control group was treated with nipple aspirator and manual milking, where compared prognosis in breast swelling, cracked nipple and the success of breast-feeding between the two groups.Results: After the intervention of the two groups by statistical treatment, breast swelling and cracked nipple in the observation group was significantly lower than that in the control group (x2=8.23,x2=7.37;P<0.05). The pure breast-feeding rate of observation group was significantly higher than that of the control group (x2=10.87,P<0.05). Conclusion: The PolinGer rehabilitation therapy instrument with nipple aspirator and manual milking can significantly improve breast swelling and cracked nipple of primipara, and significantly enhance the success rate of breast feeding. It is worth popularizing in clinical application.
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Objective To observe the surgical effect of nipple retractor to inverted nipples.Methods Between January 2001 and January 2014,this nipple retractor to inverted nipples was used to correct 604 inverted nipples of 322 patients.The follow-up period ranged from 6 to 24 months.The clinical results and complications were evaluated.Results Excellent nipple morphology and patient satisfaction were achieved in 211 cases (93.8 ％),basically normal nipple morphology and patient satisfaction were achieved in 12 cases (5.3％),and recurrent nipple inversion occurred in three cases (1.3％).The latter three patients had experienced failed open correction for their inverted nipples,and some degree of nipple inversion occurred after removal of the frame.In this study,28 patients (12.4 ％) experienced successful pregnancy and breast-feeding.No loss of nipple sensation occurred in 225 cases.Nipple erection was observed after stimulation in 215 cases (95.6％).Conclusions The described technique is minimally invasive,simple,safe,and reliable.Satisfying aesthetic results can be achieved without destroying breast feeding function and nipple sensation.
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Objective To explore the effect of subcutaneous composite flaps by crossed filling and supporting within areola combined with continuous distraction on moderate and severe inverted nipple.Methods 33 patients with 59 moderate and severe inverted nipples were involved in this study.The bilateral subcutaneous triangular composite tissue flaps pedicled with the base of the nipple were harvested within areola,the two triangular composite tissue flaps were revolved and advanced either horizontally to the opposite pedicle through the tunnel beneath the nipple and fixed as supporting.After the operation,the continuous distraction of the nipple lasted for two to four weeks,clinical effect and complications were analyzed.Results None of these 59 nipples appeared blood circulation disorder after operation.Postoperative follow-up for 6 months to 3 years showed that 54 inverted nipples were corrected completely without complications,such as nipple and areola necrosis,and there were no recurrence.The patients and doctors were satisfied with the appearance of the nipples.Conclusions Correcting the moderate and severe inverted nipple with subcutaneous composite flaps by crossed filling and supporting within areola combined with continuous distraction is simple,microinvasive,effective,and the incision scar is invisible,and it therefore is an ideal method for correcting the inverted nipple.
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Objective To investigate the treatment of inverted nipple by continual extension with S tractors made of Kirschner wires on the base of preliminary clinical obervation.Methods Under local anesthesia,with the inverted nipples being dragged out by a presutured thread or a pair of towel clips,a Kirschner wire of 10 cm long and 0.5-1.0 mm in diameter was transversly penetrated through the base of inverted nipple.Then the Kirschner wire was bended at both points of 1.5 cm distantly from the nipple center in clockwise cemicircularly.Two cemicircular Kirschner wires were folded downward hingelikely and the center axis was supported by two cemicircles.This folded S tractor pushed and supported the inverted nipple forwardly and constantly.The hinge angle was adjusted during the treatment according to the traction requirment.It was nessessary for wearing these S tractors for at least 6 months before the Kirschner wires were being taken out.During referrals,the hinge angle was revised for mentaining the extension efforts.Results We treated 32 cases of inverted nipple,total 58 moderate and severe lesions,with this method effectively.No infection was observed during the treatment.The nipple form was naturally and stably outstanding after Kirschner wires taken out.No relapses were observed during a mean 6 monthe following up.Conclusions This procedure is simple and convenient without the need of complicated surgical procedures or perplexed equipments.The nipple shaps are observed natural and stable after Kirschner wire is removed.No recurrences are observed.There are no damages to breastfeeding function.The obvious drawback of this method is its reqairing of long continuously wearing and its inconvenience.
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Objective To observe the effect of continuous elastic outside distraction on the expression of basic fibroblast growth factor (bFGF) and transforming growth factor-beta 1 (TGF-β1) in the female porcine nipples,and to further investigate the mechanism of continuous elastic outside distraction stimulation on the proliferation of supporting tissue in nipples.Methods Three female minipigs were employed,each of them had 12 nipples.Four nipples of each minipig were used as control group,while the other eight nipples were continuously distracted with prefabricated instruments.One nipple without distraction and two distracted nipples of each minipig were excised at 2,4,8,and 12 weeks after operation under general anesthesia respectively.The excised nipples were prepared for immunohistochemical staining to observe the expression of bFGF and TGF-β1.Image analysis software was employed for quantitative analysis.Results bFGF and TGF-β1 expression of control groups was weaker than those of the distracted groups at any time (P＜0.01).The expression of bFGF increased gradually after tracted and reached the peak at 4 weeks.There was significant difference (P＜0.05) in the expression of bFGF between 4 weeks and 12 weeks groups.The expression of TGF-β1 was increased to the peak after 2 weeks.The expression of TGF-β1 between 8 weeks and 12 weeks groups and 2 weeks group had statistical significance (P＜0.05).The expression of bFGF and TGF-β1 had a positive correlation during the traction.Conclusions Continuous elastic outside distraction can promote female minipig nipple to synthesis and secretion of b-FGF and TGF-β1.
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Objective To investigate the difference between simple continued traction and areola dermal flap filling in inverted nipple correction surgery.Methods There were 60 nipples of 32 patients in simple continuous traction group and 62 nipples of 32 patients in dermal flap filling group.Follow-up was conducted for 12 months.The surgical results were compared with statistical analysis.Results Wound healing,nipple shape,blood supply,feeling and breast-feeding function in simple continuous traction group were better than those of the dermal flap filling group.There was no statistically significant difference in diameter and height of nipple,nipple retraction and relapse rate between the two groups.Conclusions Simple continuous traction is superior to dermal flap filling.Both methods are safe and effective for the treatment of various types of inverted nipple and two groups of patients have improved in symptoms and appearance.
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Objective To explore the effect of elastic outside distraction on microvessel density and to illustrate the mechanism correcting inverted nipples. Methods Three female 3-month-old minipigs,with 12 nipples each,were employed.4 nipples of each minipig were remained without distraction were control group,and the other 8 nipples were continuously distracted with inverted nipple correction instruments.Corresponding nipples were excised at 2,4,8 and 12 weeks after traction.The excised nipple specimens were employed with immunohistochemical staining to detect the expression of vascular endothelial cells growth factor (VEGF) and CD34 in those tissues,and the percentageof positive cells and microvessel density (MVD) changes were counted.Results The expression of CD34 and VEGF in the experimental groups increased at 2 weeks after tracted,and reached at the peak at 4 weeks,then gradually decreased during 8 to 12 weeks after tracted.While those were weakly positive in control group.Compared with the control group,the integral optical density of VEGF-positive cells and MVD were significantly different (P＜0.01),and there was a significantly positive correlation between MVD and VEGF.Conclusions Continuous elastic outside distraction can promote the expression of VEGF and CD34 in female minipig nipple and enhance angiogenesis,which increases oxygen supply locally,and therefore those local tissue proliferation may be one of key mechanisms of correcting the inverted nipple by continuous elastic outside distraction.
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ObjectiveTo observe the effect of continuous elastic outside distraction on female minipig nipples and their supporting tissues,and to investigate its mechanism to correct inverted nipples.MethodsThree female 3-month-old minipigs with 12 nipples were employed.4 nipples of each minipig were remained without distraction as control group,and the other 8 nipples were continuously distracted with inverted nipple correction instruments.Corresponding nipples were excised at 2,4,8 and 12 weeks after traction.Before excision,the diameters and heights of nipples were measured with a vernier caliper.Then the excised nipple specimens were employed for HE staining to observe the change of their tissue structure and the number counting of capillaries.ResultsThe volumes of nipples all obviously increased after traction,as compared with control group,and diameters and heights of nipples were significantly different (P＜0.01).In addition,there was a trend that nipple height increased with traction time.Under light microscope,the traction group showed that epidermis thickened,basal cells,fibroblasts and capillary significantly proliferated.Capillary counts compared with the control group were significantly different (P＜0.01).ConclusionsContinuous elastic outside distraction can promote the proliferation of female minipig nipple and areola papillaris.
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Objective To explore a new surgical treatment for severe inverted nipple and to reduce the possibility of recurrence. Methods Two opposite long six-side polygon de-epithelialized areas were designed within the range of areola on both sides of the nipple. The four sides in lateral portion were dissected and two wedge-shaped dermal and glandular tissue flaps were created, completely releasing the contractive fiber causing nipple retraction while reserving breast ducts. The flaps were reversed 180 degrees through the tunnel bilateral sides of breast ducts to support the nipple. It was tracted for 3-4 weeks by series 7 needle penetrating the nipple basis. Results All the 14 patients were followed up for 3-18 months, and they were satisfied with the appearance and the aesthesia of the nipple and no recurrence was observed, breast-feed function reserved in 2 cases after childbirth. Conclusions This operation is easy to perform with satisfying aesthetic outcome and breast-feed function remaining.It is an ideal method for correcting serious inverted nipple.
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Objective To explore a new methodology with bilateral rhomboid dermal flaps for surgical treatment of inverted nipple. Methods 36 cases with 64 inverted nipples were involved in this study. Among these cases, 8 of them were evaluated as mild degree, while 19 moderate and 9 severe. In this procedure, the bilateral rhomboid incisions were designed. The rhomboid skin was deepithelialized and two dermal flaps were created. Then these two dermal flaps were filled crosswise through the tunnel beneath the nipple and fixed as supporting. After the operation, the continuous traction of the nipple lasted for one week, and sutured out 10 days later. Results None of these 36 cases appeared nipple blood circulation disorder after operation. Postoperative follow-up for 6 months-3 years showed that the appearance of the nipple was satisfactory. There were no recurrence and sensory disturbance. Conclusions The method introduced in this study is simple, the appearance of nipple is natural and no complication has been found. The incision is larvaceous while the scar is invisible. Meanwhile this method is also benefit for reserving the function of breast-feeding. It is proved to be an ideal method for correcting the inverted nipple.
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PURPOSE: Severe type of inverted nipple (cannot be pulled out above the areola plane by manipulation, grade III) usually cannot be corrected by a relatively simple pursestring suture technique. Most patients want to avoid visible scars. To treat the severe case and avoid visible stigma, we introduce this invisible dermal flap method. METHODS: This new surgical procedure makes bilateral incisions on the sidewall of nipple and dissections vertically to free the ducts from the contracted tissues. After dissection, the tunnel is formed. We insert "dermal flaps" into the tunnel underneath nipple base. Then through-and-through sutures are performed vertically (6 o'clock and 12 o'clock positions) and the purse-string suture is added with 4-0 nylon. RESULTS: We had treated 35 primary inverted nipples (grade III) in 27 patients and 13 recurrent nipples in 7 cases. The results were excellent in 45 nipples (93.7%). All but 3 recurred cases was fully or very satisfied with the results. CONCLUSION: This technique is effective for the correction of severe inverted nipples and recurrent cases. We can avoid the visible scars on the areola surface
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Humans , Cicatrix , Contracts , Nipples , Nylons , Skin , Suture Techniques , SuturesABSTRACT
Objective To introduce a simple, effective and less wounded approach to rectify an inverted nipple. Methods Patients lian down in a horizontal position, two circles were drawm in diameters of 2.5 cm and 3.5 cm, respectively, in the centre of nipple. Routine disinfection and local anaesthesia were performed, a small incision in 0.3 cm was cut around inner and outer circular arc each, and then # 4 and # 7 threads were buried, respectively, under inner and outer cycles of skin. The inverted nipple was lifted by crossing those two threads, tying # 4 and # 7 thread (not so strong), and finally incisions were sewn by 5.0 thread. 7 days later, stitches were removed but no extrusion done within 3 months after surgery. Results Lactation was normal, and nipple and mammary areola were satisfied by patients. Conclusion The main cause of inverted nipple is imbalance growth for nipple and mammary areola muscle, and lack of tissue to support under nipple. Using double buried purse-ring suture, it is not only strong the nipple root, and block the gap when nipple is retracting, but also make nipple be beautiful and does not affect lactation. It is an easy and useful operation, with less damage to normal tissues and quick recovery.
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PURPOSE: An inverted nipple presents both cosmetic and functional problems. It is a source of repeated irritation and inflammation, and interferes with nursing. In addition, its abnormal appearance may cause psychological distress. With consideration of its underlying pathophysiologic components and severity, a number of techniques have been introduced for correction of this anomaly. The diversity of techniques indicates the lack of a good, sustainable, and durable solution for this quite common problem. We report our method as an alternative solution for correcting of the inverted nipple. METHODS: From August 2003 to November 2007, 273 nipples in 147 patients were treated. 126 patients had bilateral inverted nipples. Patient age at the operation ranged from 21 to 63 years(mean age, 34 years). All nipples were congenital anomaly. 45 nipples were graded as grade I, 179 nipples as II, and 49 nipples as III. In the our study, we made some modification to the classic purse-string suture: (1) twice purse-string suture: (2) excision of diamond-shaped skin at the nipple neck: (3) buried suture of the breast parenchyma at the nipple base: (4) some timely release of retraction using Bovie's electrocautery dissection at inner surface of the nipple neck. RESULTS: The operation time averaged 15 minutes. The mean follow-up period ranged from 3 to 48 months, with an average of 8.4 months. There were no complications associated with the surgery, such as infection, hematoma, permanent sensory disturbance, or total nipple necrosis except temporary sensory loss in 9 cases, partial nipple necrosis in 7 cases, and recurred inversion in 15 cases. All patients except recurred inversion were satisfied with their results. CONCLUSION: We believe that our modified purse- string suture is a reliable, simple, safe, and effective method for correcting the inverted nipple.
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Humans , Breast , Cosmetics , Electrocoagulation , Follow-Up Studies , Hematoma , Inflammation , Necrosis , Nipples , Skin , SuturesABSTRACT
Objective To explore a new methodology for surgical treatment of severe retracted nipple in women. Methods 20 patients with inverted nipple and 4 recurred patients were involved in this study. Firstly, the site of neonipple tip was marked in the central part of the inverted nipple and its mean diameter usually was 1.2-1.5 cm. Then two shallow and deep triangular pedicled flaps were designed, respectively, in both superior and inferior areas near areola. With temporary traction of the nipple apex provided by a stay suture, the fibrotie bands underneath the nipple base might be cautious-ly released. Moreover, the shallow skin flaps should be about 0.5 cm in thickness and their blood sup-ply was from the subdermal arterial rete of the areola, which were used to cover and reconstruct the neck area of neonipple after a clockwise rotation and advancement simultaneously. While the deep fas-cia tissue flaps were revolved and advanced either horizontally to the opposite pedicle or upward to the inner tip through the tunnel underneath the nipple base in order to improve the height or width of the neonipple neck and prevent flattening as the supporting tissue and their blood supply was from some small perforating branch arteries in the deep part of mammary gland. Finally, purse-string suture was necessary in the base of neonipple which played a key role in avoiding recurrence of nipple inversion. Four vertical diamond-shaped excision-suturation treatment in neck area could make improvemts on the height of those stout and short nipples. Results In all 24 cases corrected by shallow and deep triangu-lar flaps rotation, after 3-6 months' follow-up, there were no complications related to surgery such as infection, hematoma, permanent sensory disturbance, or nipple necrosis, and postoperative recovery was rapid and uneventful. Especially, follow-up data revealed no evidence of recurrence of inversion and all patients were satisfied with their results. Conclusions Triangular flaps and fascia-tissue flaps in shallow and deep areola rotation is effective and easy to be popularized in correction of inverted nip-ple. This technique can improve both the diameter and height of the nipple, and certainly lower the re-currence rate of nipple inversion and achieve good aesthetic results.
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In spite of various surgical treatments to correct the inverted nipple, no one is free form its recurrence. It is well known that stable suspension of projected nipple is required after nipple reduction. To minimize the recurrence rate, authors designed a new suspension device using Aquaplast Thermoplastic(Optimold) which is heat-malleable. The retracted nipple was held up with 2 traction sutures using 4-0 nylon, and then the surgical correction was performed. The projected nipple was suspended by 2 traction sutures with 4-0 nylon. A sheet of Aquaplast Thermoplastic (Optimold) was tailored by 1.5x5cm. It was soaked in hot water for 5-10 seconds. In 30 seconds, it was molded by manual in " omega" shape after dry-up. This prepared splint was applied on the nipple and areolar. 2 ends of nylon threads were pull upward and other 2 ends downward from the splint. Then, they were tied on top of the splint. The suspension sutures maintained for 7 days. From January of 2003 to December of 2006, we corrected 12 inverted nipples in 9 patients. After operation, we applied these devices for suspension to all nipples and 11 of them were kept corrected for more than 6 months. The authors consider this suspension method is simple, quick and effective. And the splint is very comfortable to patient because it is small, light and fits in nipple. In addition, it is very convenient to check the circulation of the operated nipple by sight.
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Humans , Carboxymethylcellulose Sodium , Fungi , Nipples , Nylons , Recurrence , Splints , Sutures , Traction , WaterABSTRACT
PURPOSE: The inverted nipple presents many problems in both cosmetic and functional aspects. The histopathologic features of inverted nipple are that inverted nipple has less fibromuscular tissue than normal nipple, short lactiferous duct and dense fibrous tissue. Many papers have been reported for correction of the inverted nipple, however not many medical literatures has specifically described about traction method. Although traditional traction methods were using half of urine cup or lid of bottle, they were uncomfortable and incapable for wearing brassiere. METHODS: We invented a simple and more natural method using a dome-shape plastic disposable lid of take-out cup. We applied new device for three patients after corrective surgery. RESULTS: For long term follow up, all patients satisfied their postoperative status and they were comportable with the lids. CONCLUSION: This new method is very simple, comfortable, and effective method for traction. It also allows patients to wear the brassiere.