Correction of Inverted Nipple using Nipple Suspension with Areola-based Dermal Flaps
Jin Sik Burm, MD, PhD and Yang Woo Kim, MD, PhD
INTRODUCTION: Traditional surgical techniques using areolar dermal flaps used to correct the inverted nipples, which have the concept of adding the tissue bulk or strut beneath the nipple and tightening the nipple neck (1-5). Areolar dermal flaps attached to the nipple neck can be pulled down together with the nipple due to postoperative retraction, which can result in recurrence of inversion, especially in severe cases. If the bases of dermal flaps are placed on the areola that is supported by compact subcutaneous tissue, these flaps may resist retraction forces effectively (Figure 1). So, we developed a nipple suspension technique using areola-based dermal flaps for correction of moderate and severe inverted nipples.
METHOD: Moderate or severe inverted nipples were marked with two or four diamond-shaped quadrangles, respectively (Figures 2 and 3). The short diagonal of quadrangle lay on the circle of the nipple neck. After deepithelialization of quadrangle areas, full-thickness skin incisions were made on two sides of the nipple portion and on one side of the areolar portion of quadrangle. The diamond-shaped dermal flaps were raised with a pedicle along the one side of areolar portion of the quadrangle. A subcutaneous tunnel was made beneath the nipple by repeated vertical splitting and stretching maneuvers with fine scissors. The periductal fibrous tissues and lactiferous ducts were released fully without severing all the ducts. The tips of the flaps were turned down through tunnels and sutured to the areolar dermis at the base of opposite flap. The nipple was supported by two or four areola-based dermal flaps each of which had two rigid areolar fulcrums. A donut dressing was applied with no nipple traction splinting.
RESULT: In all cases of 28 nipples in 17 patients with moderate or severe inverted nipples, there was no evidence of recurrence of inversion and no complications. Most cases (27 nipples) exhibited excellent nipple projection, including cases with very severe inversion due to periductal mastitis.
CONCLUSION: A new nipple suspension technique using areola-based dermal flaps is based on the simple principle that underlies the support of a suspension bridge to simultaneously support the nipple and tighten the nipple neck and trunk. Then it allows for correction of all types of inverted nipple and preserves the lactiferous ducts with excellent results.
Figure 1. Differences in long-term support of the corrected inverted nipple produced by nipple-based areolar dermal flap (A) and areola-based dermal flap techniques (B).
Figure 2. Schematic diagrams of nipple suspension using two areola-based dermal flaps for the correction of moderate inverted nipples.
Figure 3. Schematic diagrams of nipple suspension using four areola-based dermal flaps for the correction of severe inverted nipples.
REFERENCES
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