An Integrated Approach to the Repair of Inverted N

Authors: Stevens W Grant Fellows David R Vath Steven D Stoker David A

Publish Date: 2004/05/01

Volume: 24, Issue: 3, Pages: 211-215

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Abstract

Methods We performed initial nipple eversion using gentle traction with a skin hook The nipple base was approached with the use of an inferior periareolar incision through the subcutaneous tissue Blunt dissection parallel to the ducts restored varying degrees of projection Selective ductal division was performed as necessary to obtain complete eversion with normal projection To maintain the nipple in an overcorrected position we placed a nylon traction suture through the center of the nipple and affixed to a stent consisting of a medicine cup and gauze paddingConclusions The technique for correction of nipple inversion reported here is focused on blunt dissection through vertical spreading parallel to the lactiferous ducts with selective division of only those ducts that restrict nipple projection The use of traction stenting helps ensure eversion and protects the repair The technique produces excellent results without recurrence of nipple inversionNipple inversion is a disfiguring condition caused by hypoplasia of the lactiferous ducts that affects approximately 2 of all women1 It is classified into 3 grades on the basis of the degree of hypoplasia2 A grade I nipple can be everted manually and maintains its projection without traction In grade II the nipple is more difficult to evert and returns to the inverted position without traction Grade III nipples are severely retracted and inverted Numerous techniques for correction of the inverted nipple have been described1–16 and may be broadly categorized into those that divide the lactiferous ducts and those that do not At the time of this writing no consensus exists as to the best method for treating this deformity In this article we present a new integrated approach to the correction of nipple inversion Figure 1

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