• Breast Augmentation
• Breast Lift
• Breast Asymmetry
• Inverted Nipple
• Breast Cancer
• Breast Reconstruction After Mastectomy
• Reduction Mammoplasty
• Gynecomastia

Inverted Nipple

If you are wondering about whether or not your nipples are inverted, gently compress the areola (the pigmented area around the nipple) between your thumb and forefinger. Most nipples will protrude. Flat nipples donÌt do anything at all. Inverted nipples will retract. It is not unusual to have one nipple that is flat or inverted and one that is not.

There are several different types of inverted and flat nipples:

• Dimpled. Only part of the nipple protrudes. The nipple can be pulled out but does not stay that way.
• Unilateral. Only one breast has an inverted or flat nipple.
• Inverted. There are two different possible degrees of nipple inversion. There is a slight inversion and a moderate to severe inversion where the nipple retracts deeply when the areola is compressed, to a level underneath the areola.

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Causes of the Inverted Nipple

• Hereditary. This condition may be an inherited family trait.
• Trauma. An injury to the breast tissue may cause long term scarring of the fibrous bands connected to the nipple, the subsequent scarring can then cause a shortening of the bands resulting in the inversion of the nipple.
• Previous surgery. Surgery, such as a breast biopsy can also cause a shortening of the fibrous bands beneath the nipple and cause inversion.
• Breast Tumor. The presence of a breast tumor may also cause inversion of the nipple.

What gives the Breast its Shape?

The breast consists of milk ducts and glands, surrounded by fatty tissue that provides its shape and soft feel. (Fig. see diagram in inamed pamphlet pg. 2)
Situated beneath the breast is the pectoralis major muscle.

The skin envelope surrounds the breast mound and the nipple areola complex is connected to the underlying milk ducts and fibrous bands whose shortening may cause inversion of the nipple.

Your Consultation

Before considering surgery to release an inverted nipple, all patients will need a pre-operative consultation. At this time we review your medical history and perform a physical examination to ascertain if you are indeed a candidate for the surgical release of an inverted nipple. We have found that this procedure is not usually covered by insurance.

Dr. Rucker's experience in the treatment of Inverted Nipples

Dr. Rucker completed his Plastic Surgery Residency in 1984. Because of his desire to devote a large portion of his practice to Restorative Breast Surgery, he chose to attend a fellowship in Breast Surgery in Atlanta, Georgia. He became board certified in Plastic and Reconstructive Surgery in 1986 and attained the position of Fellow in the American College of Surgeons in 1989. During his 22 years of practice in west central Wisconsin, Dr. Rucker has performed approximately 800 restorative breast procedures

The Treatment for the Inverted Nipple

The treatment options range from conservative to operative. A conservative approach called the Hoffman technique may help to loosen the adhesions at the base of the nipple. Place a thumb on each side of the base of the nippleÛdirectly at the base of the nipple, not at the edge of the areola. Push firmly against your breast tissue while at the same time pulling the nipple and loosen the tightness at the base of the nipple, which will make it move up and outward. Repeat this twice per day. The surgical release of the inverted nipple is accomplished by a release of the fibrotic bands beneath the nipple that are causing the problem. Care is taken to avoid damage to the lactiferous ducts; however in severe cases the preservation of these structures may not be possible. The surgery is done under a local anesthetic on an outpatient basis. The operative time is approximately one hour.

The Recovery

Most patients rate the pain level as a 1 on a scale of 1 to 10. All patients are given detailed postoperative written instructions and prescriptions for pain control and an antibiotic. Normal activity is tolerated well in the first week. Your final consultation usually occurs 5 months after your procedure.

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Questions Welcome

Dr. Rucker and his staff hope that this information will be of help to you if you are considering the correction of an inverted nipple. Your inquiries are welcome.

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Risks

There is a potential for complications in any operative procedure. The most common being infection, scarring and sensation changes. During your consultation a detailed discussion of these potential risks will be given to you.