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|
Flat nipples are also quite common. This entails a lack of nipple projection due to a lack of nipple skin. Flat nipples are not tethered; they just remain flat despite heat, cold, and stimulation.
|Flat nipple repair|
Surgical treatment of both inverted nipples and flat nipples is essentially the same. Over the last 20 years, my technique has evolved to utilize very small incisions for these repairs.
Surgical sequence (about 30 minutes per nipple in the office under local anesthesia):
- 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.
- We provide laughing gas (70% nitrous oxide) to help you feel tipsy.
- Local anesthetic is injected to the surgical site. After this, you will experience no pain.
- Two sutures are placed in the center of the nipple to enable traction.
- A small incision (about 3 mm or 1/8th inch) is made adjacent to the nipple.
- Fibrous bands are divided to “release” the nipple, enabling improved nipple projection.
- An absorbable “purse-string” or drawstring suture is placed around the base of the nipple, further improving projection and preventing recurrent retraction or flattening.
- The 3 mm incision is closed with two or three absorbable sutures.
- A surgical dressing is applied to protect the repair and to splint the nipple in its new projecting position. The dressing “sticks out” quite a bit, so we usually refer to it as “the Madonna bra.”
- You can drive yourself home. The laughing gas wears off in about 10 minutes.
- We will remove your Madonna bra dressing and the traction sutures one week after surgery. Your nipple correction should be immediately apparent.
- You will treat the 1/8” incision with antibiotic ointment for about another week.
- You will need to avoid compression of the nipples for about 6 weeks. This means going without a bra 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