Patient 4 Gallery

Before and after bilateral inverted nipple correction in a 33 year old woman. She had not had children yet and was relieved to hear that future breastfeeding should still be possible. We take a conservative approach when patients are nulliparous (have never been pregnant) and realize that situations and preferences about having a baby can change with time, so we always preserve a robust connection of milk ducts to the nipple as best we can.

Her nipples were graded as Grade II-III. Grade I inversion means they can self-correct with a pinch or stimulation – they have a slit in the center when they are relaxed but they will come out fully after a pinch. Grade II inversion means the nipples have some degree of nipple protrusion with stimulation but they cannot fully come out. Grade III inversion means the nipples are completely buried and they have minimal correction with nipple pinching, similar to a deep crater.

The higher the grade of nipple inversion, the more challenging the correction surgery is but the more rewarding to our patient! This woman’s surgery involved making an incision around the base of the nipple. A “marionette stitch” placed after injection of numbing in the nipple helped to pull the nipple outwards. Dissolving sutures were placed in the base of the nipple to create a more stable base. Additional dissolving “bolster sutures” were placed around the base of the nipple to help keep the nipple “everted” (the opposite of inverted) during healing. Sometimes these sutures are removed at a follow-up visit but other times they are left in place to help maintain correction of inversion, particularly when there is a higher grade of nipple inversion.

Follow up photos are shown one month after surgery. This patient had fairly large nipples that formerly were buried, but are now evident! The irregular texture of the nipple glands will gradually become less projecting and less rough as they are exposed to normal exposure to clothing and bras. She started to regain her sensation in two weeks. It often takes several weeks to months for nerves to start to wake up. We have been promised an update about breastfeeding ability when that happens in the future!