A new surgical technique for the correction of the inverted nipple

Abstract

Many techniques have been proposed over the years to correct the inverted nipple, a condition which causes both aesthetic and functional problems. In more severe cases, other than causing infections and inflammations, breastfeeding is impossible because of the lack of nipple erection. Reconstructive surgical techniques today are oriented toward methods that allow adequate filling to maintain the nipple permanently everted. In the technique we propose, the nipple is pulled out and extruded by way of a periareolar incision after sectioning the galactophorous ducts and fibrous tissue. To guarantee a permanent eversion, a single trilobed dermoglandular flap is created, overturned, and fixed to fill the "dead space" below the nipple after the lobes have been sutured together. Finally, two transfixed U-shaped sutures are employed to keep the flap in place. From an analysis of the various techniques and results obtained, this method appears to be effective above all in resolving the aesthetic problem in a stable manner and is simpler than the techniques that employ multiple flaps.

Correction of Inverted Nipple: Comparison of Techniques with Novel Approaches

“…Al, 2004;Jiang et al, 2008;Yamada et al, 2004;Ritz et al, 2005;Huang , 2003;Crestinu, 2001;Pompei & Tedesco, 1999). No single technique is appropriate for correcting all the types of nipple deformities because different grades of inverted nipple have different levels of fibrosis, soft tissue bulk, and lactiferous ductus stucture .…”

“…No single technique is appropriate for correcting all the types of nipple deformities because different grades of inverted nipple have different levels of fibrosis, soft tissue bulk, and lactiferous ductus stucture . Some of the techniques include construction at the base of the nipple by using areolar dermal flaps (Kim et al, 2003;Kim et al, 2006;Huang 2003) modified suturing ''t'' (Stevens et al, 2004;Serra-Renom, 2004) or a combination of these two (Pompei & Tedesco, 1999) to prevent the collapse of the nipple. Other techniques use alloplastic materials, i.e., silicone or PTFE, where extrusion is a potential complication; they have their own limitations (Serra-Renom, 2004).…”

Trilobed Skin Flap on the Face: For Reconstruction of Full-Thickness or Commissural Defects

“…Ohtsuka and coworkers 4 used this flap in facial reconstruction in patient with hemangioma. Because the trilobed flap has an erect (right angle) pattern, Tanabe et al 5 and Pompei and Tedesco 6 used this flap in inverted nipple reconstruction. Masakazu 7 used the perforator‐based trilobed flap for coverage of lumbosacral defects.…”

The study of expanded tri-lobed flap in a rabbit model: possible flap model in ear reconstruction?

“…by Sushruta and a slightly more professional procedure than that of Sushruta was recommended in about 300 A.D. by Celsus, who described the repair of an auricle by creating quadrangular advancement flaps and the treatment of concomitant atresia by drilling the bone and plunging the hole. As early as 1597, the Italian surgeon Tagliacozzi described and illustrated repair of both upper and lower ear deformities with skin flaps from behind the auricular region [5]. Until today, more flaps, techniques and implantation materials have been described for reconstruction of the ear [6-9].…”

“…Ohtsuka used this flap in facial reconstruction in a patient with hemangioma [3]. Since tri-lobed flap has a right angle, Tanabe and Pompei used this flap for reconstruction of inverted nipple [4,5]. Masakazu used perforator-based tri-lobed flap for coverage of lumbosacral defects [6].…”