Corrections of the Breast Nipple

This type of correction is associated most frequently with the corrections performed at the level of mammary areola within breast reconstruction following a mammary tumor. There are many practices that correct the nipple by using surrounding tissues. When the abscission is unilateral a fragment of the healthy breast mammilla could be transplanted to the rebuilt breast.

The results are good in any case although for symmetry it is preferred to transplant a fragment of the contralateral nipple if possible.
In case of massive mammary reduction through amputation, nipple reconstruction will be performed by employing any of the reconstruction practices based on local flaps.

Another type of pathology at the nipple level that could be corrected surgically is given by their interposition. This consists of a nipple distortion which in stead of being prominent to the external as it is natural, these are “recessed” in the areola. The correction of this might occur spontaneously during a breast increase procedure with implants if this is wished for.

Usually there is congenital issue, but it could be related to scars generated by breast lactation, infections of the mammary ducts or prior breast surgeries. Nipple depression could cause functional problems such as irritation, redness and discomfort, or might remove breast lactation. Surgical correction is chosen most of the times for aesthetic reasons.

The problem of invaginated nipple occurs with 2% of the women. It is anatomically related to the contraction level of the mammary ducts, which drag down the nipple, as well as to the quantity of tissue remained at the basis or neck of the nipple. There are many levels of indrawn:

• Level I: the nipple could be drawn out easily and could be kept in this position;
• Level II: the nipple could be drawn out hardly; it tends to depress easily;
• Level III: it is difficult or impossible to draw out the nipple

Over the years the treatment consisted of many practices, originating since 1888. The procedures are divided into two big groups: some keep mammary ducts and other cross them. More than 20 surgical procedures have been described, the practices varying from nipple neck or base thickening, tissue admixture at the nipple base, incisions for scar contracture release, up to internal suture incisions made to support the nipple. Although the treatment is very efficient, 1% of the patients do not obtain the results they want!