The nipple is a duct filled structure which connects the glandular tissue of the breast to the skin. It is a very sensitive and active structure to allow for a mother to nurse her baby as well as a sensual organ with many nerve endings. Unfortunately, the nipple can be source of functional and cosmetic deformity with different degrees of height discrepancy. An inverted nipple is the most common functional and cosmetic problem of this area. It is secondary to tethering of the ducts within the nipple likely secondary to either iatrogenic scarring from irritation or inflammation, or congenital problems secondary to shortening or constriction that developed in-utero. No matter what the initial problem, there are different degrees of this problem based on the ability of nipple to project or erect spontaneously or with manual manipulation, as well as the ability of the nipple to maintain its projection. There are different methods of correction depending on the degree of inversion. They may involve a simple suture technique which helps tighten the base of the nipple to release of the tethering nipple tissue. This can be combined with filling the nipple with small fat grafts or dermal grafts which can be harvested at the time of breast augmentation or other breast surgery. These procedures do have risk of decreasing sensation and function of the nipple, though the most common risk is partial correction or recurrent inversion. The major concern in the correction of the inverted nipple is to maintain breast duct connection to the skin in order to preserve the ability to breast feed. This can be preserved in many of these procedures and risk and benefits of each procedure should be discussed with patients and each individuals concerns taken into account when planning the surgery. In general, isolated nipple surgery can be performed under local anesthesia in a minor procedure room with minimal recovery.
Nipple height can not only be decreased as in the inverted nipple, but can be increased with an overly projecting or long nipple. This problem can begin after breast feeding, but may be congenital. Long or oversized nipples may be a source of embarrassment and are commonly covered up with bra padding and pasties, but are difficult to conceal in bathing suits and when naked. Most women believe that this problem cannot be corrected and they are “stuck” with them, or they are embarrassed to seek treatment for the size of the nipple. Activities and clothing can be avoided because of this problem. Nipple height can be decreased with a very minor wedge excision of the nipple with a turn-down upper nipple flap. This procedure does disrupt the continuity of the nipple ducts and does make breast feeding not possible. It is easily performed under local anesthesia in a minor procedure room with minimal recovery.
All nipple procedures including decreasing the diameter of the areola, as well as correcting the length of the nipple can be performed easily and can be combined safely with breast augmentation, breast enhancement with breast implants and breast lifts (mastopexy) and reductions. The beauty of nipple surgery is that this area heals with minimal scarring.
Dr. Trussler will individually discuss each concern with the look and function of nipple and tailor the correction to each patient’s age and request, including the desire to breast feed.
