The Correction of Severe Inverted Nipple: Using Under Skin Dermal Flaps, Through-and-Through Suture and Purse-String Sutures

ABSTRACT

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