Correction of Inverted  Nipple

Using4-flapMethod

Purpose

 Various operation methods have been reported on the correction of an inverted nipple. Although most methods brought about satisfactory outcomes, an under-correction, prominent scars, failure to breastfeed, sensory disturbances, and still more have noted. Especially on recurrence, an inadequate dissection and weak support barriers appear to be the main cause of the failure. The conspicuousness of the scar seems to result either from wide dissections or several incision lines. Hereupon, we present a simple four-flap method, which will not only provide support barriers of satisfaction, but also minimize the scar.

Materials and Method

 We applied to 60 nipples of 30 patients, including 4 recurred nipples (2 patients) from previous operations using another method. Under local anesthesia, the first step was to elevate two de-epithelized triangular-shaped flaps that form the base of the nipple at 3 and 9 o'clock positions of the areola. The size of the equilateral triangle was about 6~8mm for the base and 10mm in height (Fig.1). In the second step, for the projection of the nipple and the protection of the lactiferous duct, subcutaneous tunnels had been built under the nipple, using a vertical dissection with the application of the traction suture. (Fig.2) The third step was to make triangular dermo-parenchymal flaps of similar sizes, based at 3 and 9 o'clock positions. And then, for the fourth step, the two nipple-based flaps and the two areola-based flaps were crossed under the subcutaneous tunnel and sutured at the counter wall. Through the previous step, two layers of support barriers can be made under the nipple. (Fig.3) Fifth step was suturing for skin closure. In the process of the suturing, the longitudinal incision line of the base of the flap is changed into a transverse line. This brings about a tightening effect of the base of the nipple.(Fig.4)

Results

 For all cases, satisfactory results have been obtained, concerning the projection and the shape of nipple as well as the operation scar. There also was no report on recurrence.

Conclussions

 We could make corrections of the inverted nipples using this method of relative simplicity.  One other merit this method is the possibility of operating at any direction of the areola on recurrence.

               (Fig.1) Method: Step I

               (Fig.2) Method: Step II

               (Fig.3) Method: Step III,IV

               (Fig.4) Method: Step V