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Inverted Nipple Repair
Inverted nipples or retraction of the nipples is a condition in which the nipple ducts are shorter than normal and there is a tethering or pulling inward of the nipple. Retraction of the nipple is caused by a short milk duct system running from the chest wall to the nipple. Although a benign condition, it is usually perceived as a problem for women who wish to breast-feed. Development of nipple retraction in adults should be evaluated to make sure a tumor is not the cause of retraction. Today, there are two types of procedures that address this - those that preserve ductal integrity and those that do not.
How much it cost?
The cost differs for each individual case and surgeon to surgeon, according to where they practice. There may be additional costs such as anesthesia, operating room facility, prescription medicines, etc.
What happens during the procedure?
The surgery is normally performed at a hospital or outpatient clinic and takes 1-2 hours. If you decide to go ahead with the procedure, there are two techniques used today:
Inverted nipple repair with partial preservation of milk ducts: Your doctor will administer a local anesthetic as well as a sedative to help you relax. An incision will be made just around the base of the nipple on the areola. The nipple and areola tissue is lifted from (but still connected to) the breast and stitched into a new, projecting shape utilizing a “purse-string” style of suturing (stitches). Because of the circular shape of the scar around the nipple, scar contracture will actually increase rather than decrease nipple projection. Medicated gauze is then applied to the site.
Inverted nipple repair with detached milk ducts: This procedure is much more common and may be necessary in more difficult cases but it does not preserve ductal integrity. Your doctor will administer local anesthetic, and you will be offered a sedative. An incision is made at the nipple base, and the shortened milk ducts are detached, allowing a natural-looking projection of the nipple. The incision is sutured closed, and medicated gauze is applied to the site.
Are there risks or potential side effects?
As with all surgeries, there is always a possibility of complications, including infection, a reaction to the anesthesia, hematoma, seroma, nerve damage, the need for second or sometimes third procedures and the occurrence of asymmetries or irregularities. Should infection occur, your surgeon will prescribe a treatment with antibiotics.
The ability to breastfeed cannot be guaranteed after any surgery to correct inverted nipples. Be sure to ask your surgeon about all of the risks associated with the procedure your considering before you make any decision.
What to expect post-procedure?
The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keep your head elevated, above the level of your heart, when lying down. Applying cold compresses, or small ice packs will reduce swelling and relieve discomfort. Many patients use a watertight plastic sandwich bag filled with an ounce of frozen berries or peas. Regular icing is the key to relieving swelling and the resulting pain.
Post surgery, the nipples will be covered with medicated gauze. Under the gauze will be tiny, stitched incisions. As with any surgery, you may feel the after-effects of the anesthetic. Most likely, you will be allowed to leave the hospital within a few hours after the surgery, but you should have someone else drive you home. You will probably be allowed to shower the next day.
As with any surgery, it is also sometimes normal to feel anxious or depressed in the days or weeks following the operation. If there is heavy bleeding or increased pain, be sure to inform your surgeon.
How soon does normal life resume?
Most often, swelling is mild to moderate, peaks two or three days after the procedure, and then eases up over the following three weeks. Bruising may occur. Sutures (stitches) are usually removed about four days after surgery. You will probably be able to return to work within the week, unless your work involves strenuous activity.
Are you a good candidate?
As with all elective surgery, good health and realistic expectations are prerequisites, but if you are concerned about breastfeeding, then inverted nipple repair surgery may be appropriate, especially if:- You have no known ophthalmic problems like glaucoma or a detached retina, nor any medical condition such as high blood pressure, circulatory problems, hypothyroidism or other thyroid related conditions.
- You tell your surgeon about any and all medical conditions and any allergies you may have as well as all medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription).
- You are not prone to scarring problems such as keloids.
- You have a good understanding of the healing process and the limitations of the procedure.
Make sure to discuss all of the options available with your gynecologist before making a decision.
How to prepare for this procedure?
Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines:- Avoid aspirin, any aspirin containing medication or any other non-steroidal anti-inflammatories (NSAID), such as Motrin® or Advil®, for two weeks prior to treatment. Because aspirin thins the blood, it can interfere with normal blood clotting and increase the risk of bleeding and bruising.
- Smoking inhibits the healing process, so stop smoking before your procedure and if you start again, make sure it is after you are completely healed.
- Avoid drinking alcohol a few days before your surgery.
- Make sure to follow any fasting instructions the night before and morning of your surgery. Your doctor may insist on an empty stomach depending on the type of anesthesia.
- Make sure that you arrange for someone to bring you home and to help you out for 24 hours after surgery.
Are there alternatives to this procedure?
Women who want to correct inverted nipples in order to breastfeed more easily should know that they have other options in addition to plastic surgery. First of all, contrary to popular belief, breastfeeding does not involve the nipple so much as the breast itself, and a hungry infant can achieve quite a vacuum, pulling a moderately recessed nipple out into his/her mouth. Many women interested in breastfeeding are concerned that their nipples are inverted, whereas in reality their nipples will serve quite adequately--when the time comes--without medical assistance. (The true inverted nipple is reportedly rare. It is characterized by a tendency to retract when the area around the nipple is squeezed.) A flat or even slightly recessed nipple will not necessarily prevent successful breastfeeding.
For pregnant women, there are little plastic devices available called breast shells that can be worn in your bra during the last months of pregnancy to help bring out inverted nipples. They work by putting pressure around the base of the nipple, which pushes the nipple out. If they are worn several hours a day in the last trimester, they should help the condition. If you don't find out until after the baby comes, it is not too late. Breast shells can be worn between feedings, but it might take a few weeks for the nipple shape to improve. You can buy them at maternity stores or from a lactation consultant.
If you do have flat or slightly inverted nipples, you may be able to gently pull them out with your fingers (far enough out for the baby to latch on to). And some mothers have been able to get them to stand out by putting a cold cloth on them.
Locate a certified physician with our Doctor Locator.
To view Personal Stories about this procedure contributed by our members, Click Here.
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