MALAYSIAN SOCIETY OF PLASTIC RECONSTRUCTIVE SURGERY

INVERTED NIPPLE REPAIR

DR FAIZAL ALI

Plastic,reconstructive AND COSMETIC  Surgeon

Plastic Cosmetic Surgery

Johor Bahru


An inverted nipple is a condition where the nipple instead of pointing outwards is retracted into the breast. It can be present since young (congenital) or it can be caused by breastfeeding, infections or as a sign of breast cancer. An inverted nipple can be graded from 1 to 3 depending on the severity of the retraction. A grade 3 inverted nipple is one in which the nipple is severely retracted and difficult to pull out. Inverted nipple surgery can help to restore the nipple to a beautiful and natural, projecting appearance. 

During the initial consultation, patients will have the opportunity to discuss their goals and desirable results with the plastic surgeon. Every patient is different, therefore a specific treatment regimen is planned to suit an individual’s need.


Procedure

The procedure is usually performed under local anaesthesia. Some patients who are unable to tolerate the procedure under local anaesthesia might opt for general anaesthesia or if inverted nipple surgery is performed with other procedures as well. The surgery takes about an hour.

An incision is usually made just around the base of the nipple on the areola. Working through the incision, the surgeon gently spreads the fibres within the nipple. In more severe cases these fibrose ducts will need to be cut in order to correct the inversion. Once the fibres are spread and the nipple is free and in an outward, normal position, special sutures are placed inside the nipple to add stability to the base of the nipple. The small stab wounds around the nipple are then close with fine sutures.

Once the procedure is completed, a light dressing and antibiotic ointment will be applied to the incision site. A cold compress will be applied while you are waiting in the recovery room. The surgeon will advise you on how to take care of the wounds at home and you will be given a follow-up appointment.



 Candidates for Inverted Nipple correction

1. Generally healthy individuals with well-controlled medical conditions such as hypertension or diabetes (if they have any)
2. Individuals with clear and realistic expectations of their desired result.
3. Women with grade 2 or 3 inverted nipples.



Risks of Inverted Nipple correction

Although serious complications from inverted nipple surgery is uncommon, potential candidates should understand that every procedure comes with it a certain risk for possible complications and has a recovery period (down time). Preoperative preparation and postoperative preparation will minimize their incidence.


The more common complications from inverted nipple surgery are:

1. Bleeding (primary or secondary)
2. Swelling
3. Bruising
4. Infection
5. Poor wound healing (especially in smokers)
6. Numbness
7. Scarring
8. Asymmetry
9. Possibility of revision surgery
10. Anaesthesia risks



These risks mentioned above can be eliminated if proper preoperative and postoperative instructions are followed.



Preoperative Preparation

1. Stop all non-medical supplements for at least one week before surgery.
2. Stop taking any anti-inflammatory pain medications , blood thinning medications (anti-platelets, anti-coagulant), 
    and aspirin one week before the procedure.
3. All medical conditions (hypertension, diabetes, etc) need to be optimized prior to surgery.
4. Smokers need to stop smoking well in advance.
5. Some individuals might require prior blood investigation or further medical assessment.




Postoperative 

After the surgery, there will be some swelling, bruising, discomfort, numbness and discoloration for several days that can be controlled with oral medications, cold compression and ointments. The swelling and bruising usually last between 2-3 weeks but in some patients, this can last longer.

Oral antibiotics and analgesics will be prescribed to reduce the risk of infection and postoperative pain respectively. Stitches will be removed about 7 days after the surgery. The final result of surgery will appear within several weeks, but it may take up to a year for the scar to fully mature.




Care

1. Cold compression with an ice pack the first day and night after surgery.
2. Regular antibiotic ointment on the surgical wounds.