![]() ![]() The flaps were fixed to each other at three of the respective vertices with 5–0 polyglactin sutures. The triangular flaps were rotated about the axis and downturned into this pocket such that the deeper surfaces of the flaps were in contact with each other, while the superficial surfaces were in touch with the walls of the dissection pocket ( Fig 4). This dissection was carried out bluntly to avoid injury to the lactiferous duct ( Fig 3). With the nipple under gentle traction, a vertical tunnel was created deep to the central portion of the nipple. The tip of the opposite triangular flap, B, is then fixated to A’, to which C and C’ are approximated.Įach of the triangular flaps were de-epithelialized and elevated to include the areolomammillary muscle layer and subcutaneous tissue just above the breast parenchyma ( Fig 2). The tip of the triangular flap, or A, is overturned and fixated to B’, which is the dermal point to which D and D’ of the areola are approximated. The long axis of the triangular flap is equal to the diameter of the nipple base (BB’ = B’A’ = A’A). After traction of the inverted nipple, the circular area of the nipple base becomes larger. B’ is the dermal point of approximation of D and D’ from the areola, and A’ is the dermal point of approximation of C and C’ from the areola. The red dotted circle means the base of the nipple before traction. A schematic diagram of the design of the method for inverted nipple correction.įull-thickness subcutaneous triangular flaps are designed as shown in the diagram after pulling out the inverted nipple. In the current study, we introduce a modified operation with rotated-buried flaps and report clinical outcomes of this technique, along with a review of the literature.įig 1. ĭespite the variety in corrective operations, postoperative recurrence of inversion remains a problem. Due to its simplicity and effectiveness, this method came to be used widely both in its original and modified forms. Elsahy originally proposed the use of bilateral triangular dermal flaps that cross under the nipple. Over time, a number of methods have been used to correct the condition. Nipple inversion is not rare, with reported prevalence ranging from 1.8 to 3.3%. This deformity can pose aesthetic, psychological, and functional problems such as difficulty with breastfeeding. In patients with inverted nipple, a relatively short lactiferous duct is attached to the nipple via dense and highly inelastic connective fibers. ![]() The condition was first described by Cooper in 1840, and the first corrective operation was reported by Kehrer in 1879. An inverted nipple is a condition in which a portion of or the entire nipple is buried below the plane of the areola. ![]()
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