American Society of Plastic Surgeons
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NurseDawn
3 years ago
Answered

Nipple release

Hello.I had mastopexy w/nipple release 6wks ago.My BCPS dissected the underlying structures, then tucked a piece of rolled skin & adipose tissue under the nipples. There has been no change to inversion. He suggests a revision to place more tissue under the nipple in about 6wks. Is this best practice? Alternatives? Suggestions?Also, now one nipple is numb, so my concerns grow. TY ;-)

Procedure: Breast Lift
Location: chesterfield, VA

Replies 6

Michael Law
ASPS Surgeon
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I'm sure it is frustrating to see no change in your nipple inversion six weeks postop. Nipple inversion is caused by tethering bands of fibrous connective tissue that pull the nipples inward and prevent them from projecting outwards. Two modifications of the breast anatomy below the areolas are generally required to create a fully everted (outwardly projecting) nipple:

1. Complete release of tethering connective tissue bands that are pulling the nipple inward.

2. Placement of tissue in the space where the tethering bands were released to hold the nipple everted while the surgical site heals, and to prevent scar tissue from forming at that location which might create a recurrence of nipple retraction.

If your nipples have never projected outward postoperatively, then there was either incomplete release of the tethering bands, or inadequate tissue inserted into that space to hold the released nipples in an outwardly projecting position, or some combination of the two.

Without question you will require a secondary surgery to achieve outward nipple projection. I would advise against early reoperation, however. Nipple eversion surgery has the potential to reduce nipple blood flow somewhat, so the blood supply of the area needs some time to recover. Additionally, you underwent a mastopexy (breast lift) procedure performed simultaneously, which also can - at least temporarily - reduce nipple-area blood flow.

I strongly recommend giving your breasts six months to recover from the mastopexy and attempted nipple eversion procedure. Then make sure your surgeon can clearly describe to you, ideally with the help of hand-drawn diagrams, their plan for achieving complete and lasting nipple eversion when your second procedure is performed.

A technique that I have found to be very reliable is the elevation of a flap of subareolar tissue on each side of the nipple. Each flap is passed through the area of tethering band release to the other side and secured with sutures. These flaps hold the nipple in its newly everted position, and prevent recurrence of nipple retraction. The flaps represent vascularized, living tissue, so they will not disappear over time as can often happen with dermal-fat grafts and packaged graft materials like acellular dermal matrix (ADM). The linear scar on each side of the areola (from flap elevation) is usually faint to even invisible over the long term.

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Jon Ver Halen
ASPS Surgeon

Dear NurseDawn,

Hello and thank you for your excellent question. Based on your description, you treatment plan is reasonable. I suggest that you continue to follow your surgeon's recommendations. If you do not note an improvement after 6 months, it would be reasonable to either seek a revision, or a second opinion. If you have any questions, call our office for assistance. Good luck!

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Larry Weinstein
ASPS Surgeon
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Nipple inversion is a difficult problem to fix permanently. It sounds like your surgeon is doing reasonable procedures to address the problem. I usually use a permanent stitch under the nipple to establish projection after releasing nipple attachments. This procedure cam be done under local anesthesia in the office. After this procedure you cannot breast feed. Good luck...

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Eric Wright
ASPS Surgeon

Thank you for the question. Nipple inversion can be a surgical challenge. The procedure that you had sounds like a reasonable option. If the connective tissue that is causing the inversion is not released, then placement of any further tissue will not work. Once released, then either suture techniques or tissue placed can help prevent scarring or further retraction. Loss of nipple sensation is a possible risk since the small nerves could be injured at the time of the procedure. I would continue to follow up with your plastic surgeon to discuss further options.

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Anne Taylor
ASPS Surgeon

Hello, Nipple eversion can be down with an external incision, and release of the tethering ducts, and then some tissue can be placed to maintain the eversion. If the eversion does relapse, it can be repeated. Other dermal fillers and materials can be placed in the nipple as well to maintain the desired projection. Good luck.

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Katerina Gallus
ASPS Surgeon
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Hello and thank you for your question. The procedure you have had sounds appropriate. Nipple inversion is a difficult problem to correct and a second surgery may be necessary. Numbness is a possible result of the procedure although sensation may return in the next six months. I encourage you to be patient and follow up with your surgeon. I wish you the best of luck.

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