Definition and relevance of the problem
Inverted nipple is a relatively common problem. According to scientific literature sources about 2% of the female population has inverted nipples.
Inverted nipples cause many different problems: poor hygiene of areola area, breastfeeding difficulties, psychological distress, dissatisfaction with one’s appearance, repeated inflammation of the nipple.
The vast majority of cases associated with congenital causes, it can be a genetic predisposition to suffer from this disease. Acquired nipple involvement usually occurs as a consequence of chronic inflammation, oncology process, macromastia, after surgical procedures. Nipples inversion is influenced by factors such as the insufficiency of supporting tissues, hypoplasia of the lactiferous ducts, and retraction caused by fibrous bands at the base of the nipple.
Physicians widely use the classification based on the amount of effort needed to pull out the nipple manually, the duration of the nipple protrusion after manipulation, and the amount of fibrosis existing around the nipple.
In grade I inversion the nipple is easily pulled out manually and maintains its projection quite well. Grade 1 nipples have minimal fibrosis.
The majority of inverted nipples belong to the grade II inversion. The nipples can be pulled out, but cannot maintain projection and tend to retract. These nipples have moderate fibrosis beneath them.
For the grade III group the nipple can hardly be pulled out manually because of severe fibrosis.
The inverted nipple correction is usually performed under local anaesthesia or general anaesthesia during complex procedures.
For grade I inversion manual traction and a single buried purse-string suture, which is performed through 5 mm incisions in the nipple base, is enough for the correction.
In grade II inversion surgical dissection is performed until the inversion does not recur after the traction is released. The purse-string suture is used for nipple shape fixation.
If the nipple is not turned out (grade III inversion), precise surgical dissection of fibrotic fibres is performed preserving lactiferous ducts. Dermofibrotic or sub-dermal flaps are created to fill the area under the nipple and make the foundation to preserve nipple protrusion.