Introduction: The condition of inverted nipple was first described over 160 years ago. Since then a large number of conservative and surgical techniques have been described for its correction. The large number of techniques and modifications, described over the years, demonstrate that the ideal solution for correction of this condition has not yet been found. We present a new technique for management, based on our observation that Grade III nipple inversion is due not only to shortness of the ducts, but also to skin deficiency around the nipple. Steps of the technique: We use traction of the nipple with a hook, and make an incision around the base of the nipple. This is followed by careful circumferential supperficial undermining, avoiding injury to the ducts as well as the vascular and sensory supply of the nipple. A defect of about 1cm long is thus created around the nipple. A radial eliptical full thickness skin graft is then harvested from the areola, draped around the defect of the nipple and secured with a stent. The donor site is closed with a running nylon suture. This procedure was performed under local anesthesia in five women with Grade III bilateral nipple inversion. Results: Our follow up ranged from two to seven years. There were no immediate or late complications, or recurrences; the shape of the areola was not distorted and all scars were inconspicuous and barely visible; three patients who became pregnant after the procedure, were able to breast feed without problems. Conclusions: Based on our experience and our long lasting results we believe that our technique is very useful for the management of Grade III inverted nipples. It is simple, respects the anatomy of the area and results in adequate and permanent projection of the nipple without loss of sensation or erectile function. There is perfect color match of the graft and the surrounding tissues and the scars are inconspicuous; full nursing ability is possible. Steps of the procedure will be demonstrated in detail and representative cases with long term follow-up results will be presented.

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