Congenital inversion of the human nipple

Crowdsourcing the Public's Perception and Systematic Review of Nipple Inversion and Its Repair

Background: Nipple inversion is a common condition seen in 10% of females. Patients often present with physical insecurities and difficulty breastfeeding and would be best counseled initially by a primary care provider. We examined the body of literature and public perception of nipple inversion to provide a patient-centered perspective of the condition and its repair. Materials and Methods: We conducted a prospective cross-sectional study surveying random volunteers using internet crowdsourcing. Studies examining the correction of nipple inversion reporting posttreatment recurrence rates were considered for systematic review. Results: Five-hundred three people were surveyed, and 398 (mean age 35.6 years, 57.9% female) were included in final analysis. Seventy-one (17.8%) have or once had nipple inversion, and 18 (31.6% of females with nipple inversion) reported resultant difficulty breastfeeding. One-hundred thirty-five (33.9%) would advise repair, and 283 (71.1%) would advise repair if unable to breastfeed. Two-hundred eighteen (54.8%) would search online for more information about nipple inversion. Forty-four studies, including 1,940 patients and 3,361 nipples, were examined for systematic review. Seven techniques severed lactiferous ducts, and 31.8% reported breastfeeding outcomes, but as a number of patients. Studies were inconsistent in the reporting of baseline patient data and outcomes. Conclusion: Nipple inversion may be more common than previously reported. The majority of people would consider surgical correction, advice someone with nipple inversion to undergo repair for breastfeeding, and consult online resources for more information. Methodological and reporting limitations of existing evidence limit conclusions regarding the superiority of operative techniques with regard to patient satisfaction and breastfeeding outcomes.

A Modified Inverted Nipple Correction Technique That Preserves Breastfeeding

BACKGROUND

An inverted nipple may affect the appearance of the breasts and breastfeeding, but traditional surgical procedures might injure the normal lactiferous ducts and damage sensory functions.

OBJECTIVES

The aim of the study was to propose a minimally invasive and reliable method that preserves breastfeeding and corrects grade I and II inverted nipples.

METHODS

This was a randomized controlled trial of 230 female patients with unilateral or bilateral inverted nipples and 30 patients with normal nipples who visited the Preconception Counseling Department of our hospital from February 2009 to January 2016. The nipples in the distractor group underwent an operation with a distractor, while the control nipples were treated with daily exercises. The intervention lasted 6 months. The primary endpoint was full-term pregnancy breastfeeding for 4 months. The secondary endpoint was the completion of lactation without obvious complications, such as mastitis and nipple craze.

RESULTS

Grade I and II nipples achieved increased height after the distractor was worn for 6 months and at 37 weeks of pregnancy (P < 0.05), while the control nipples achieved only a marginal improvement at 37 weeks of pregnancy. In the distractor group, the success rates were 84.9% and 79.3% for grade I and II nipples, respectively, compared with the control group (52.5% and 38.9%, respectively) (P < 0.05). After treatment with the distractor for 6 months, nipples in the distractor group showed no complications, such as skin numbness or nipple necrosis.

CONCLUSIONS

The use of a distractor is a reliable and minimally invasive method for correcting grade I and II inverted nipples while preserving breastfeeding.

LEVEL OF EVIDENCE: 2

Treatment of the benign inverted nipple: A systematic review and recommendations for future therapy

The inverted nipple is a frequently encountered problem which can cause difficulties with breastfeeding, sexuality, and aesthetic dissatisfaction. Up to now, no consensus exists on a preferred treatment method. We performed a systematic review to identify the best treatment method for correction of benign inverted nipples. Treatment techniques were subdivided in the categories lactiferous duct preserving and lactiferous duct damaging. A systematic review was performed using the PRISMA statement. Inclusion criteria were: female patients with congenital or acquired inverted nipples, a minimum sample size of 10 nipples, and studies reporting recurrence of inversion with a minimum follow-up of six months. Exclusion criteria were nipple inversion caused by malignancy. Thirteen studies met the inclusion criteria which all had a level of evidence IV. No non-invasive treatment techniques were identified. In the duct preserving category eight studies were included with a recurrence rate of 0.6% (2/350) versus 9.9% (16/161) in the duct damaging category (n = 5). Other outcome parameters were not systematically reported in all studies. Because of a small number of low quality studies with heterogeneous interventions and outcomes a meta-analysis could not be performed and no preferred treatment method was identified. Based on the available data there is no statistical evidence that duct damaging treatment is superior to duct preserving treatment. We recommend that the first method of choice should be a duct preserving treatment method. In the future, more studies of better methodological quality are required and recommendations were made on how these could be conducted.

A method for correcting an inverted nipple with an artificial dermis

Various methods have been reported to correct an inverted nipple. Although a satisfactory outcome has been reported with most techniques, each method carries a drawback inherent in the technique itself, including complicated operative technique, sensory disturbance of the nipple, marked scarring of the nipple areola and other donor regions, destruction of breast function, and incomplete correction. This report describes a simple method for correcting an inverted nipple. It incorporates a new concept of using artificial dermis for tissue augmentation and is performed without sacrificing any donor site and complex design. It was applied to four nipples in two nulliparous cases. For all four corrected inverted nipples, good results were obtained, and there have been no complications. There were no deformities of the nipples or the areolas after this procedure, and the surgical scars were inconspicuous.

Correction of Inverted Nipple

Inverted nipple, which is defined as a nipple located on a plane lower than the areola, presents both functional and cosmetic problems. It is a source of repeated irritation and inflammation, and interferes with nursing. In addition, its abnormal appearance may cause psychological distress. Inverted nipples are congenital or acquired, and are classified as the umbilicated and invaginated types or divided into 3 groups (grades 1, 2, and 3). With consideration of its underlying pathophysiologic components and severity, various surgical procedures have been proposed. For correcting the inverted nipple, the authors introduce an alternative, simple method using 2 triangular areolar dermal flaps. Compared with other methods using triangular areolar dermal flaps, each triangle is approximately 1 mm shorter than the diameter of the nipple, and the deepithelialized areolar dermal flaps are lodged at the slit in the bundle of the lactiferous ducts in the grade 2 inverted nipple. From August 2000 to December 2001, 11 patients (16 nipples) were treated. Five patients had bilateral inverted nipples. Patient age at operation ranged from 18 to 31 years (mean age, 27 years). All nipples were congenital and they had no previous operation. Thirteen nipples were grade 2 and 3 were grade 3 according to the classification of inverted nipple by Han and Hong. The mean follow-up period was 8.7 months (range, 3-12 months). Follow-up examinations revealed no evidence of recurrence of inversion. There was no complication associated with surgery, such as infection, hematoma, permanent sensory disturbance, or nipple necrosis. The resulting scars were minimal. All patients were satisfied with their results. The authors conclude that their procedure is reliable, preserves the lactiferous ducts in grade 2 inverted nipple, requires no special postoperative care, and leaves minimal scars and no recurrence of inversion. This technique can be applied to any type of inverted nipple as a primary surgical procedure.

The inverted nipple: to cut the ducts or not?

Much dilemma exists as whether to divide the lactiferous ducts or not when correcting an inverted nipple. We report a series of 26 cases (44 nipples), which have undergone correction with or without duct division. Eversion was maintained in 59% of nipples. Analysis of the failure groups revealed similar rates of failure for umbilicated nipples whether the ducts were divided (27%) or not (25%). Invaginated nipples showed an increased tendency to reinvert postoperatively if the ducts were not divided (80%) than if they were (42%) (not significant). Permanent loss of nipple sensation was noted in 20% of cases when the lactiferous ducts were divided. Postoperatively two women were able to breast feed despite complete division of their lactiferous ducts. Women with umbilicated nipples are usually able to breast feed. We believe that correction of the umbilicated nipple can usually be successfully performed, and function maintained without dividing the ducts. Correction of the invaginated nipple requires duct division. The underlying pathogenesis and varying methods of correction are reviewed.

Inverted nipple: the new method of correction

A new technique for correcting inverted nipples is described. It consists of the sectioning of the only genetic factor--the resistance of the collagen fibers--by undermining, under the control of a palper. The trophicity of the nipple is assured by a circular "umbrella" musculocutaneous flap containing the superficial vascular system. A subdermal cutaneous notch "blocks" the nipple and prevents any recurrence.

Treatment of the postoperative inverted nipple with or without asymmetry of the areola

Postoperative inversion of the nipple is a possible complication in reduction mammoplasty, especially when a tendency toward inversion exists prior to surgery. A technique for correction is presented, leaving no more scars than the peri-areolar scar corresponding to the nipple transposition. Dermal flaps are used to prevent recurrence. Any asymmetry in the location of the areolas or excessively high position can be corrected simultaneously.