Nipple aesthetics can be evaluated under 3 topics:
- Inverted nipple
- Swollen and Enlarged Nipples
- Regeneration of a nipple in the absence of a nipple (Nipple reconstruction)
1) INVERTED NIPPLE (Collapsed Nipple, Inverted Nipple, Retracted Nipple, Collapsed Nipple, Retracted Nipple)
Nipples are featured structures comprising of a brown round areola and a protruding tip and they play an important role in the appearance of the breasts. A special muscle right under the nipple is responsible for it to enlarge and take an apparent shape in response to touches, stress, cold and menstrual cycles.
There are openings in the nipples where the mammary ducts from the breast tissue are connected. Retraction of a nipple is called embedded nipple or inverted nipple. Generally, embedded nipples are caused when the mammary ducts from the breast tissue are short or the muscle behind the nipple is contracted.
It is mostly caused by congenital or growth-depending reasons which cannot fully be understood. Rarely, it can be seen after breastfeeding, inflammatory conditions, trauma, breast sagging and in situations which breast cancer may affect mammary ducts.
The inverted nipple is classified as follows and its treatment is determined accordingly:
- Mild: When pressed around the areola, it protracts and maintains its shape.
- Medium:When the tip is squeezed, it is not fully protruded, but it is immediately retracted.
- Severe: The tip is not apparent by squeezing and continuously remains retracted.
Different techniques are used in the treatment with local or sedation anesthesia; the key is to pull out the nipple without harming mammary ducts. In addition, contracted tissues should be cut to release the nipple and pull it out. In order to prevent recurrence of the problem, after pulling out the nipple, different tissues such as fat or muscle may be placed under it as a support. Nowadays, methods involving the cutting of mammary ducts are not recommended.
In mild and medium cases, the nipple can be pulled out by surgery without damaging the mammary ducts.
The inverted nipple is an aesthetic deformity which women are reluctant to talk about to people around them. It can be completely corrected with a simple plastic surgery. Most women with this condition are not aware of that this deformity can be corrected with a simple surgery. This problem can be seen on one or both breasts in two or three women in a hundred.
The nipple can retract after adolescence period as a result of inflammation. The underlying cause of recurrent mastitis may be a retracted nipple.
Another problem occurs during lactation and breastfeeding. Retracted nipple makes it difficult for the baby to get the nipple. Mammary ducts in a retracted nipple may prevent milk flow. Milk flow cannot be achieved and leads to the swelling of breasts. It may lead to bigger problems which are difficult to solve. If it is two-sided, the baby cannot have breast milk. No immediate surgery is possible during the breastfeeding period. So, correcting this situation is very important before pregnancy.
Treatment of inverted nipple
Generally, the contracted tissues pulling the nipple inwards are released during surgery. This process should be done with microsurgical technique and special magnifying glasses to avoid damaging the mammary ducts. Then, the support tissues can be pulled from the surrounding tissue to the base of the nipple to prevent retracting of the tip again. This also can be prevented by different stitching techniques.
An important aspect of the surgery is to obtain a natural appearance and maintain the sensitiveness of a nipple. During the surgery, care is taken to protect the innervating structures of the nipple.
2) SWOLLEN AND ENLARGED NIPPLES
The nipples may enlarge during adolescence period and also during lactation. Generally, patients request this aesthetics problem to be corrected by breast reduction surgery.
Enlarged nipples can also be seen in women with small breasts and it can be treated by a simple surgery. In such cases, the problem can usually be corrected by small intervention performed under local anesthesia. Successful results are obtained when the surgery is performed by using magnifying glasses and microsurgical techniques. After the surgery, reduced nipple size, which retains the normal sensitivity with intact milk supply, is achieved.
When planning an operation, a suitable method is determined depending on the problem. Large nipples may be reduced and the length of nipples can be shortened. The brown round area surrounding of the nipples (areola complex) may be too large. This area may be reduced and an aesthetical appearance may be achieved.
3) REGENERATION OF A NIPPLE IN THE ABSENCE OF A NIPPLE (Nipple reconstruction)
Reconstruction of the nipple involves the regeneration of the nipple and the areola when the nipple is absent due to the congenital or post-natal reasons. The nipple may be lost partially or completely as a result of breast cancer, infection, burn and trauma. There are different methods for reconstruction of the nipple and the surrounding areola. These methods can be divided into two groups: methods involving the transplantation of tissues obtained from the patient or the usage of other external means. Techniques involving the transplantation of tissues obtained from other regions of the body can be used; if there is a healthy nipple, it can be used to share it with the other breast and surrounding skin; shift techniques can also be used when reconstructing areola. It is also possible to provide a similar appearance to the opposite nipple with tattooing or permanent makeup as an external tool.
Nipple reconstructions are usually performed 6 to 12 months after breast reconstruction procedures following breast cancer treatment. It can be planned as a single surgical procedure to achieve the symmetry with the opposite healthy breast and can also be performed in other breast surgeries.
The absence of a nipple, deformity or asymmetry with the other breast may cause discomfort in patients and force them to seek an aesthetic surgical intervention. Nipple reconstruction may appear as an easy procedure at first, but the symmetry of it with the opposite nipple and the extent to which the nipple is to be formed should be precisely determined and carried out in well-planned surgeries.
There are many methods developed for nipple reconstruction. But one of the most reliable ones is the local flap method. Under local anesthesia, reconstruction is performed using the available tissues in the designated region of the breast. Assoc. Prof. Erdem Güven, MD performs the reconstruction of the nipple by using the technique called `Nipple Reconstruction with Ying Yang Technique` which he developed himself and made his contribution to the community of Plastic Surgery.