Your Questions
Your Questions
Q: Dr. Eppley, I have inverted nipples that are sometimes worse than other times. The left nipple is much worse. They can be manipulated to come out by squeezing on them but they won’t come out on their own. I’ve been self conscious about it my whole life. Is it possible to correct them permanently?
A: Inverted nipples can be quite variable in their presentation of depth of inversion and duration that it has been present. At least yours can be manipulated outward, which means they are not permanently contracted downward. The success for inverted nipple repair is when you can squeeze the nipple and it can come out on its own. This can be treated by either fat injections and done through a small incision to release it and placing a small fat graft into the space created when the nipple is pulled outward. Take of the fat graft should hold them out on a more permanent basis. A way to test the success of fat grafting for inverted nipples is to do a ‘trial’ of a temporary injectable filler like Juvederm Voluma. If that is successful (and it could last up to a year) then you could proceed with injectable fat grafting for a more permanent nipple inversion treatment. Otherwise if they fail to come out by injection, then they will need a surgical release and fat grafting.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in inverted nipple repair. However I don’t know anything about the procedure and how it is done. Can you help me with that information.
A: I believe you are inquiring about correction of inverted nipples. They are several types of inverted nipples based on the degree of fibrosis/tethering that is causing the inversion. The degree/type of nipple inversion cabe be determined by several factors including its presence since breast development or only developing after pregnancies/breast feeling and whether the nipple can be temporarily everted by gently squeezing it between one’s fingers or not. While all inverted nipple repairs are done by making an incision at the base of the nipple and the tether released, those inverted nipples with the greatest degree of firm inversion may require a small graft, usually fat, to fill the space that is caused by the nipple moving outward. Suturing the space beneath the nipple to hold it outward is a common technique but I have found that to be unreliable long-term at preventing relapse and recurrent nipple inversion. Thus the use of a fat or dermal graft can be very beneficial. In many cases an inverted nipple repair can be done under local anesthesia or conscious sedation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had two inverted nipple correction surgeries by two different doctors, both of which were unsuccessful. My nipples are grade III inverted. I am at a loss as to what to do. Do you think that breast implants would help in my inverted nipple correction. Would they help push the nipple out once it has been released?
A: Inverted nipple correction has a high rate of recurrent contracture/inversion after release. Your experience is not completely rare. Many methods have been described in plastic surgery for the correction of inverted nipples which speaks to the fact that it is both a difficult problem and that none of them work that well. Once the nipple has been released and brought out by suture traction during surgery, there remains a dead space or tissue deficiency underneath. I have found that filling this in with either a dermal-fat grafts or allogeneic dermis is the best way to prevent recurrent inversion. The fill must be immediately underneath the released nipple. The push from a much deeper breast implants will not work.
Dr. Barry Eppley
Indianapolis, Indiana