Improving Nipple Projection: Surgery for Inverted Nipples

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Posted August 05, 2014 in Breast Augmentation, Nipple Procedures, Uncategorized

Inverted nipples are surprisingly common, occurring in 3 – 5% of women. Instead of the nipple “pointing out,” it retracts inward, usually due to tethering bands of fibrous tissue. Most women with inverted nipples have a normal amount of nipple skin; it’s just pointing the wrong direction.

Inverted nipple repair
inverted nipple front before inverted nipple front after
Before After

Over the last 20 years, my surgical technique has evolved to utilize very small incisions for these repairs.

Surgical sequence (about 30 minutes per nipple in the office under local anesthesia):

  1. I mark the outer border of the nipple. In women with flat nipples, this outer border will be widened, in order to recruit adjacent pigmented areolar skin to become nipple skin.
  2. If desired, we provide laughing gas (70% nitrous oxide) to help you feel tipsy.
  3. Local anesthetic is injected to the surgical site. After this, you will experience no pain.
  4. Two sutures are placed in the center of the nipple to enable traction.
  5. A small incision (about 3 mm or 1/8th inch) is made adjacent to the nipple.
  6. Fibrous bands are divided to “release” the nipple, enabling improved nipple projection.
  7. An absorbable “purse-string” or drawstring suture is placed around the base of the nipple, further improving projection and preventing recurrent retraction or flattening.
  8. The 3 mm incision is closed with two or three absorbable sutures.
  9. A surgical dressing is applied to protect the repair.

Postoperative recovery:

  1. You can drive yourself home. The laughing gas wears off in about 10 minutes.
  2. You will place nitropaste ointment (to maintain blood flow) on the nipples for about a week.
  3. You will treat the incision with antibiotic ointment for about another week.
  4. You will need to avoid compression of the nipple for about 3 months. This means going without a bra, wearing loose bras, or cutting large holes in the center of an existing bra.

Keep in mind that the sole purpose of surgery for flat or inverted nipples is to improve their appearance. Women with these conditions are frequently unable to successfully breastfeed prior to surgery—and will generally be unable to do so after surgery.

Ronald M. Friedman, M.D.

Director, West Plano Plastic Surgery Center

Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas

www.https://www.plasticsurgerydallas.com