Inverted Nipple Correction

It is a very common condition that occurs in around 1 out of 10 men and women. It is often due to the milk ducts in the nipple being too short. These short milk ducts pull the nipple in, therefore not allowing it to protrude out naturally. This happens gradually and is often present since puberty since this is when the majority of breast changes occur. It can be present in one or both nipples.

An inverted nipple correction aims to correct the nipple so that it projects out in a natural way. To achieve this, your surgeon will either stretch the short milk ducts or cut them. This releases the tension that is pulling the nipple in, therefore allowing it to protrude out again.
Having a nipple correction can help boost self-esteem in patients, particularly when they are in intimate situations.

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Why have nipple inversion surgery?

Although it is painless, nipple inversion can be a distressing condition that can affect self-esteem by making the breasts look distorted. It may also be an issue for women who are trying to breastfeed. This is because the baby may not be able to latch on to flat or inverted nipples to draw the milk out of the breasts. The ideal nipple correction candidates would therefore include those who are:

Seeing little to no improvement using a non-surgical approach such as the Niplette device.
Becoming distressed or self-conscious because of their nipple inversion.
Having difficulty nursing their baby.
Wanting an effective treatment with long-lasting results.

Nipple inversion grades

Nipple inversion can affect patients to different extents. There are different grades of nipple inversion depending on its severity. Your surgeon will examine you during your consultation to determine which grade of nipple inversion you have. The 3 grades are as follows:
Grade 1 (mild)

The mildest form of nipple inversion
This can also be called “shy” nipple
Nipples may be flat or slightly inverted
The nipples evert in response to stimuli such as touch or temperature
Nipple protrusion remains for some time before they return back to their inverted state.

Grade 2 (moderate)

The nipples are slightly more inverted than grade 1
They will evert with manipulation but will immediately return to their inverted state when manipulation stops.

Grade 3 (severe)

This is the most severe form of nipple inversion
There is complete inversion of the nipples

How is a nipple correction procedure performed?

A nipple correction procedure is a relatively simple surgery to perform. It often lasts between 30 to 120 minutes depending on the severity of the inversion.
A nipple correction procedure involves the following steps:

1. Consent form

You will meet your surgeon to sign a consent form before the procedure. This will be done either on the day of your surgery, or during your pre-operative assessment a week before.

2. Anaesthesia

As this is a simple procedure, your surgeon will give you a local anaesthetic, with or without IV (intravenous sedation). In some cases however, it may be more preferable to use a general anaesthetic.

3. Incisions

Your surgeon will make a small incision at the base of the nipple to gain access to the milk ducts that are pulling the nipple inwards. The different techniques your surgeon can use depend on the severity of the nipple inversion, and include the following:

Mild to moderate nipple inversion

In patients with mild to moderate nipple inversion, the surgeon can “stretch” the short milk ducts, therefore pulling the nipple outwards. Your surgeon will lift the nipple and areola from the breast, stretching them and then suturing the nipples into their new position.

As this method only stretches the milk ducts and does not cut them, it should not affect your ability to breastfeed. However, this technique does carry a higher risk of nipple inversion recurrence.

If your nipple inversion is more severe, your surgeon may choose to cut, or divide, the milk ducts. When the surgeon cuts the milk ducts, it releases the tension that is pulling the nipple inwards. Because the milk ducts are cut, this technique will affect your ability to breastfeed. You may lose the ability to breastfeed entirely. There is however, a much lower risk of nipple inversion recurrence.

After your surgeon stretches or cuts the milk ducts, they will use stitches to secure the nipple in its new projected position. Your surgeon will discuss with you which incision is best to use for your nipples.

4. Closing of incisions

Your surgeon will use stitches to close the incision. They will then apply a protective dressing to the nipple to prevent it from retracting again.

5. Return to the ward

The surgical staff will take you back to the ward to recover from the procedure and should be able to return home the same day.

What are the main nipple correction risks and complications?

It is important to be well informed about the nipple correction risks and complications. Your surgeon will discuss these with you during your consultation.
The nipple correction risks and complications include the following:

Inability to breastfeed

Depending on the type of surgical technique your surgeon uses, your ability to breastfeed may reduce or be lost completely. Your surgeon will however, try their best to conserve as many milk ducts as possible. Because a nipple correction can affect your ability to breastfeed, your surgeon will usually advise that you complete your family before having your procedure.

Scarring

As surgery requires your surgeon to make surgical incisions, scarring is unavoidable. Your scars should be minimal and will fade over time. The severity of your scarring does however, also depends on the ability of your skin to heal. Some patients are at risk of developing more severe scarring such as hypertrophic or keloid scars. Most patients will already be aware if they are likely to develop these types of scars.

Seroma

A seroma is a pocket of fluid that can develop under the skin’s surface. It usually develops below the incision line, and is usually mild. It will often resolve on its own but in some cases, your surgeon may have to drain the fluid out.

Numbness or loss of nipple sensation

Some patients may experience alterations in their nipple sensation. This can either be an increase in nipple sensitivity (over-sensitivity), a reduction in nipple sensitivity (numbness) or nipple pain. Any changes in nipple sensation are usually temporary and should settle within a few months. It is possible for these changes to become permanent, although this is very rare.

Infection

Infection is a risk that comes with any surgery. In most cases, these are mild wound infections that settle down with antibiotic treatment. If however, the infection becomes more severe, you may need to have further surgery.
It is important to be aware of the signs of an infection. You should tell your surgeon if you experience any of the following:

A temperature of 38° C or over
Redness and/or swelling at the incision site that worsens over time
Pus-like or foul smelling discharge coming from the incision or the drain sites
Increasing pain that is not relieved by pain medication

Aesthetic

It is important to be aware that you may be unhappy with the aesthetic results of your nipple correction surgery. For example, you may not be happy with the size, shape or symmetry of your nipples. To reduce the risk of disappointment, you should make sure your surgeon understands your expectations.

Nipple re-inversion

After a nipple correction, there is a chance that your nipples may invert again. If this does occur, it is likely to happen in the first few days to weeks after your surgery. The chance of this happening also depends on the technique your surgeon chooses to use. A technique that stretches the milk ducts as opposed to cutting them carries a higher risk of nipple re-inversion.
If your nipples do re-invert, your surgeon will discuss your treatment options with you. This may include needing to have further corrective surgery.

Necrosis

During your surgery, the blood supply to the nipples, skin or tissues may be lost. If this does occur, the affected area (such as the nipple), may die. This is called ‘necrosis’. It is a rare complication. If it does develop, you will need to have further surgery to remove the dead tissue (surgical debridement).

Bleeding & bruising

It is very common to experience some bleeding and bruising after your procedure. This usually occurs straight after surgery, and should settle down over time. The bleeding and bruising is often mild, but in some cases it can be more severe. Large amounts of bleeding may result in the development of a blood clot under the skin (haematoma).

If you notice a large amount of bleeding or bruising, or if it is increasing over time, you must notify your surgeon. You may need to have further surgery to correct this. If your surgeon treats this promptly, it is unlikely to affect the outcome of your surgery.

What can I expect after a nipple correction?

Your surgeon will give you specific advice regarding your nipple correction aftercare. They should cover the following points:

Post-operative appointment

You will be usually be able to return home on the day of your nipple correction surgery. Your surgeon will schedule a post-operative appointment after your procedure. This will usually be made within 1 to 2 weeks after your surgery. During this appointment, your surgeon will remove any dissolvable stitches, examine your breasts, and address any surgical complications.
After your nipple correction, your surgeon will give you specific advice regarding the time-frames for:

Time off work
Return to sports & exercise
Showering & bathing
Return to driving

Each surgeon has different advice for nipple correction aftercare. It is therefore very important to follow the instructions that your surgeon has given, as these are specific to your recovery.

Time off work

The amount of time you will need to take off work after your nipple correction, will depend on the type of job you have. If your work involves a lot of physical activity, you will have to take at least 1 week off. If it does not involve a lot of physical activity, then you may only need 3 to 5 days off work.

Return to sports & exercise

Although you need to rest well when you return home, it is important that you do not stay in bed all day. You should take occasional, light walks after surgery. This helps the blood flow in the legs and reduces the risk of developing a blood clot in the leg (which is called a deep vein thrombosis). Despite this, you should adhere to the following advice regarding sports and exercise:

Week 1 – 2

You should avoid all sports and exercise for the first 2 weeks after your nipple correction. This is because even minor aerobic activity may increase swelling, therefore prolonging the recovery time.

Week 2 – 3

Light exercises that do not involve rigorous movement such as cycling, may be resumed.

After week 3

You should be able to resume all sports and exercise 3 weeks after your nipple correction.

Driving

As you will not be able to drive straight after your surgery, you must arrange for a friend or family member to take you home. They must supervise you for the first 24 hours after surgery. This is because you may still have some side effects from the anaesthesia and painkillers.

Scar care

There are a number of techniques that your surgeon may recommend that can aid the healing of your scars following surgery:

Scar massage – gentle massage of the scar area may benefit healing. This should only be done once the incision has fully healed and the scab has completely disappeared on its own.
Silicone sheets/gels/creams – using silicone based products on your scars for six months to one year can help reduce the appearance of scars. You may use these products only after the glue or tape from surgery has been taken off, and your incision has fully healed.
Avoid exposing your scars to sunlight or sunbeds. Use sunscreen to protect the healing skin and avoid colour differences.

Your surgeon will be give specific advice regarding the healing and care of your scars.

Results

Although you will see a difference in your nipples immediately, it may take up to 6 weeks to appreciate the full cosmetic results. You should also avoid compressing your nipples in the first few weeks after surgery. This means avoiding movements such as lying on your stomach or hugging in the first few weeks.