A Correction of Inverted Nipple by Partial Ductal Division and V-Y Advancement of Parenchyma

Sim, Hyung Bo; Hong, Yoon Gi

Abstract

The pathophysiology of the inverted nipple is characterized by less connective tissue beneath the nipple, dense fibrous tissue at nipple-areola junction and shortened fewer functional lactiferous ducts. For grade I and II nipple inversion, the dissection of dense fibrous tissue at nipple-areola junction is sometimes not enough to completely bring out the nipple and also the recurrence rate is high. These findings suggest that the shortened hypoplastic ducts might play a considerable role in grade I and II nipple inversion. The purpose of this study was to prove the effectiveness of partial ductal division and V-Y advancement of glandular tissue to correct the inverted nipple. Through a 3mm slit incision around the nipple base, partial division of lactiferous ducts was performed and V-Y advancement of parenchyma was followed. The extent of ductal division was limited only to the central portion until the nipple protrusion persisted without any support. A deep purse-string with a 4-0 permanent suture reinforced the advancement of glandular tissue to add bulk beneath the nipple, and a superficial purse-string was applied at the subcutaneous layer to avoid instability of the nipple. 168 female patients(309 nipples) underwent this procedure from April 2000 to June 2008. 37 nipples were grade I and 272 nipples were grade II. No major complication occurred. Overall recurrence rate was 4.2%(13/309). Among 17 women who had breast-fed after correction of inverted nipples, 2 women failed to breast- feed. This safe and simple technique can correct almost all pathologic factors of nipple inversion, and it can also be easily applied to reoperation cases.