The retractor was worn for 3-6 months and then could be removed. Sutures were then passed through the prefabricated holes on the retractor base and were fixed with knots and suitable tension. Two sutures were made to cross beneath the base of the nipple to elevate the nipple, and the hollow retractor was placed on the areola with the nipple and four ends of the sutures in the center. Yukun et al. treated all grades of nipple inversion for 10 years utilizing a nipple retractor made from the hollow end of a single-use syringe, then eight holes were punctured for sutures crossing the base, and the height of the retractor depended on the sizes of the nipple-areola complex and breast volume.
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This repeated all around and multiple times would protract the nipple, but a study done in 1992 by Alexander et al. determined that not only is this not helpful in breastfeeding but may actually disrupt the lactiferous ducts, and this technique has hence been abandoned. The conservative methods mainly involve using devices to create graded/sustained suction on the nipple-areolar complex to protract the nipple and maintain the protraction.Ī technique of historic significance, introduced by Hoffman in 1952, involved placement of thumbs on opposite sides of the nipple over the areola with firm downward pressure on the breast to evert the nipple, while slowly moving away from the nipple. As such, no standardized technique has been implemented. Invasive/ surgical procedures are primarily indicated for grade 3 and persistent grade 2 inversions. Non-invasive/ conservative techniques were implemented mainly for grade 1 inverted nipples with considerable success and grade 2 with partial success. Over the years, there has been a wide variety of surgical and non-surgical techniques utilized to treat nipple inversion with satisfactory and non-satisfactory results. Management mainly depends on the grade of inversion. The latter is not likely to result in nipple discharge. It is important to obtain a detailed personal and family history in both male and female patients of any breast malignancy, as well as any confounding trauma history to the breast or chest, as scarring and fat necrosis can mimic malignancy. This is generally associated with nipple discharge (serous/bloody), nipple erosion, or a breast lump. Pathological/acquired nipple inversion after puberty or breast development is more worrisome for malignancy or other abnormalities. To grade the inversion, digital manipulation is generally attempted. Many patients come for correction/ treatment when faced with lactational difficulties. If they do not resolve with puberty, they will often persist, and repair may be indicated for breastfeeding, psychosocial, or cosmetic reasons in adulthood.
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They do not tend to cause any problems then and are usually observed until puberty/adolescence for resolution. Many inverted nipples present in pre-pubescent patients will resolve spontaneously during puberty. Raffy Karamanoukian, a plastic surgeon in Santa Monica, California, in a RealSelf Q&A.Congenital nipple inversion is mainly diagnosed during a wellness regular physical by a pediatrician or general practitioner as the patient approaches puberty. RealSelf Tip: Make sure you consult with a board-certified plastic surgeon who has experience with the technique to evert nipples and who understands the specific nerve supply to the nipple as well as the best ways to prevent damage to the sensory nerves, advises Dr. After the nipple has been released, it’s sutured in the outward position with dissolvable stitches, to keep it from inverting again.” A 2015 study of 103 patients and 191 nipple corrections found that nearly 7% of women experienced a recurrence. “The dissection is performed parallel to the milk ducts so they’re not divided, to preserve breastfeeding ability in the future. Ziyad Hammoudeh, a plastic surgeon in Miami, in a RealSelf Q&A. The treatment involves a small incision at the base of the nipple and the release of the tethering bands, explains Dr. Instead of simply severing the connective tissue in the nipple, the newer technique focuses on releasing the surrounding fibers that hold the nipple in. A protective dressing is applied, to prevent infection and promote healing.
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“The release is much like popping a guitar string.” Afterward, two stitches are placed to maintain nipple projection. Jeffrey Zwiren, a plastic surgeon in Duluth, Georgia, in a RealSelf Q&A. “Care is exercised not to cut the milk ducts, but this isn’t always possible,” says Dr. Through a small incision at the base of the nipple, the surgeon uses small scissors to release the adhesions beneath the nipples that tether the nipple down, allowing it to protrude naturally. The procedure takes only a few minutes, and it’s done under local anesthesia.