Inverted Nipples - Causes & correction
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Hello! I am Adrian Richards, and I'm a plastic surgeon. Today I'm going to be talking a little bit about inverted nipple correction. Now, this is what I am really interested in and passionate about, because I've seen many patients with inverted nipples and it really can effect people. They don't like them. It makes difficult wearing clothes, often inversion is difficult to -- it can be seen through thin clothing and it makes some intimate relations difficult for some people. So inverted nipples are common and it cause distress and the most important thing is that it can easily corrected under local anaesthetic. Now there are three grades of inverted nipple: Grade I: The nipples which are inverted do evert in the stimuli and stay everted for a period of time. Grade II: Inverted nipples are inverted do evert spontaneously and don't stay everted. Grade III: Inverted and never become everted. Now, different procedure ready for these type of inversion. Grade I, these are the ones that come out and stay out for a period of time are often best treated by a suction device known as a Niplette, which is a suction device and use normally at night which tends to slightly stretch the milk ducts which causing the inversion and often they are very effective, great one for inversion. So I would normally suggest that upgrade grade I inversion certainly tries the niplette suction device. Why do people get inverted nipples? It's a shortening of the milk ducts, and the milk ducts transform the milk glands to the nipple. And some people as the breast grows, the ducts don't grow sufficiently and act to the tender pulling the niplette. So the nipple wants to come out can't come out because it's tendered. So for Grade II nipples, there are different approaches. Again, operations for low anaesthetic typically takes 10 minutes per nipple and the options are to stretch the nipple and keeping them intact, because it stretch the ducts, the ducts keeping them intact or divide them. So Grade III, these nipples would inverted and never come out. The real option is to divide the milk ducts, because the milk ducts are so strong and tethered you won't be able to tease them out to get an adequate increase in length. So Grade III, division of the ducts. The only problem with division of the ducts is you won't be able to breastfeed after the ducts have been divided. Grade II, you need to make a decision about how important breastfeeding is for you. If breastfeeding isn't crucial important, if the surgeon divides the ducts that's an assured way of correcting the nipple inversion. But if breastfeeding is very important to you, you need to discuss possible operations to lengthen the length of the duct by teasing the ducts out. So Grade I, thinking of the niplette. Grade II options are either duct, teasing out duct lengthening or duct division go throw. Grade III is really a duct division. How is a surgery performed? It sounds like a local anesthetic, like a walk-in walk-out procedure, it typically takes about 30 minutes in total. The nipple area is cleaned, local anesthetic infiltration to nipple, it really shouldn't -- and a very small incision is made, just the base of the nipple, the ducts are then divided and teased down through a very small incision and it absorbable internal stitch is used to hold the base of the nipple together to stop the inversion and they are addressing, a lot addressing over brown area, which is changed after a week, thereafter you are getting more dressings. So it's a very successful operation, minimal scarring and minimal downtime, if the ducts are divided, the risk of recurrence of the inversion is really very low and nipple sensation because nipple sensation come far the skin of the nipple which is not affecting. Nipple sensation in over 90% of cases is not affected at all. So again, if you have inverted nipples, very common 1 in 10% of population do have some inversion. If you suddenly develop inversion and you haven't had an
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