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Common Concerns Regarding Inverted Nipple Repair

san francisco ca nipple repairThe most common concerns patients have regarding inverted nipple repair are recurrence of the inversion and loss of nipple sensation. Often, it is not possible to determine the extent of tightness of the bands beneath the nipple until the time of surgery. The procedure is tailored to each woman’s anatomy as it is encountered during the procedure, and the steps taken are individualized to achieve the very best results. Because the patient is awake during surgery (but does not feel any pain), we can design and modify the procedure to suit her goals, even allowing her to peek at the interim results and modify them based on her desired outcome as the procedure is underway.

Postoperative management, specifically the marionette stitch and the ‘donut’ dressing (both of which I mentioned in my previous post regarding what inverted nipple correction entails), is as equally important to results as the surgery itself. This may be surprising to some, but consider the healing of a broken bone: the surgeon sets the fracture or secures it with hardware, but the postoperative cast/splint is vital to ensuring the broken bone heals in the proper position. The same principles apply to inverted nipple repair for the first couple of weeks!

The marionette stitch is usually only in place for a week after surgery. The special waterproof dressing conceals this stitch and does not generally need any changing or management during the first postoperative week. At the one week follow-up visit, the stitch is usually removed (without any discomfort or awareness by the patient) and the donut splint is continued. A waterproof dressing may be reapplied, or a removal donut may be provided to wear around the corrected nipple in the bra for an additional week.

Results are often evident in about two to three weeks, and sensation will typically return gradually for up to six weeks after surgery. Mild firmness in the area of the incision is common for up to three months, and some post-operative swelling is normal. Correction of inverted nipples is generally stable without recurrence of inversion, and results are consistently pleasing to patients. In fact, the most common statements heard from patients after inverted nipple repair are: “I love not wearing bras and having great/symmetric nipple projection,” or “I am so much more comfortable becoming intimate,” – all positive outcomes and encouraging commentary for this procedure!

Although rare, should correction be inadequate or if inversion recurs, repair can be redone in the office under local anesthesia, similar to the original procedure but with a slightly shorter recovery. Usually, additional bands need to be divided, with local tissue rearrangement and a strict two to three week splint-wearing period afterward. A second correction can be performed with successful outcomes as early as three to six weeks after surgery, or as late as many years down the road.

Since the incision lies at the undersurface of the nipple and the majority of structures and nerves remain intact to the nipple, sensation usually returns completely. However, this cannot be guaranteed and can potentially take several months, up to a full year or longer. All possible risks and complications are discussed with patients during a comprehensive inverted nipple repair consultation.

Dr. Karen Horton, Board Certified Plastic Surgeon

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If you have any questions or concerns regarding inverted nipple repair, or if you wish to schedule an appointment with Dr. Horton, please don’t hesitate to contact us today.



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Dr. Karen M. Horton, M.D. - Plastic Surgery, Physicians & Surgeons - Medical-M.D., San Francisco, CA