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The nipple-areola complex is the highlight of an aesthetic breast mound. In youth, the nipple-areola complex lies on the apex of the breast mound, and the nipple adds further projection to this mound. An aesthetic nipple-areola complex lies at the intersection between the vertical midline of the collar bone (clavicle), and a horizontal line above the inframammary fold. An appropriately projected nipple adds a final touch to the aesthetic of the breast mound.
There are normative measurements for the average areola and nipple diameter and projection in females and males. However, there is also individual variance on what is considered aesthetic, and what is regarded as proportional for a person’s height and breast size. Inverted nipples are are tethered into the chest and do not project normally. Inverted nipples may cause difficulties with nursing newborns. They may cause social embarrassment with certain styles of clothing or swimwear, and may lead to diminished self-confidence and withdrawal from certain social or athletic activities.
Individuals with unilateral (one-sided) nipple inversion require investigation to exclude other conditions such as breast cancer or infections, especially if it is a recent occurrence. Individuals with bilateral nipple inversion may be due to congenital or developmental causes and are less likely due to a sinister cause. The usual etiology of inverted nipples is the presence of abnormal fibrous attachments tethering the nipple down to the underlying chest or breast gland.
Nipple inversion corrective surgery releases the abnormal fibrous attachments that tether the nipple inwards. Local tissue flaps or dermal grafts may be inserted beneath the nipple to prevent a recurrence. Nipple inversion corrective surgery restores the nipple aesthetic and improves self-esteem and social functioning. This surgery is performed as an outpatient procedure under local anesthesia, with optional intravenous sedation if desired.
The nipple will be released from the underlying fibrous attachments and nipple projection restored. The surrounding fat or skin is often used to fill up the space beneath the released nipple to prevent recurrence. The scars are confined to the areola and adjacent chest tissue.
Local anesthesia is infused into the area and small incisions around the areola are performed to release the nipple. The nipple is then separated from the underlying breast or chest wall and adjacent fat or skin is used to fill the space beneath the nipple. In females who intend to breastfeed in future, meticulous surgical dissection is required to preserve the ducts to preserve lactation function. Special wound closure techniques are used for optimal postoperative results.
Many individuals are able to return to normal activities immediately following surgery. Minor bruising and swelling is expected, and will mostly resolve by the 5th postoperative day. Mild disturbances to the nipple sensation may occur but are temporary.
Showering is possible from the 2nd postoperative day onwards. Stitch removal is usually performed on the 10th postoperative day. Individuals may resume their regular exercise or sports after the stitches are removed.
Individuals are advised to avoid vigorous massage to the treatment area for 2 hours following the injection. This is to prevent spread of the botulinum toxin, which may result in potential unintended adjacent muscle paralysis. Individuals may resume their usual activities immediately following the procedure.
