Patient 14 Gallery

Before and after bilateral inverted nipple repair in a 25 year old woman. She did not like the way her nipples looked and wanted a more outward and “normal” nipple appearance. She was counselled that inverted nipples are quite common and indeed normal! However, an in-office minor procedure under local anesthesia was certainly appropriate given her goals.

The most important conversation I have with young women considering any surgery of their breasts or nipples is preservation of breast function. The two functions of the breast are (1) ability to breast feed a baby in the future and (2) erogenous sensation. As a woman and a mother myself who nursed my twins for a year, I understand firsthand how important this is for developing babies and what a bond it establishes for women who are willing/able to breast feed.

In young women who have not yet had their children or are considering having additional children, we will preserve both these breast functions at all costs. We take a more conservative approach to inverted nipple correction in these patients, preserving at least 50% of the connections between the breast and the nipple. While there is never a guarantee that future nursing will be successful, we protect this anatomy and give women the very best chance for successful nursing.

An inverted nipple correction involves injection of local anesthesia in the office for a short outpatient procedure. Surgery is performed under operating microscope glasses (loupe) magnification. A semicircular incision is made around the bottom of the nipple. Tight bands that are pulling the nipple backwards and creating the “slit” appearance to the nipple are released until the nipple is able to protrude outward.

A temporary “marionette stitch” is kept in place for around a week to ensure the nipple heals outward in its new position. The base of the nipple is repaired and stabilized. All incisions are hidden within the base of the nipple and/or the areola. A couple of days off work (or out of the office) are recommended. When the numbing wears off, pain medication is usually required for just the first 24 hours. All sutures are dissolving.

Patients are seen in follow up at one week after surgery, 1-2 weeks after that, at 6 weeks, 6 months and a year. These follow up photos are shown at around 6 weeks. The nipples are still mildly swollen and increased blood flow to the healing area results in a pinker areola hue. The blood supply will return to normal and the areola and nipple will be less pink at around 3 months after surgery.