Recent Trends of Management of Nipple Abnormalities

Abstract

Any deformity of the nipples may be the cause of much anguish and embarrassment, however, the problem may extend beyond just the aesthetic aspect. An abnormal nipple or nipples may be linked to serious underlying disorders or structural defects that can affect the functioning of the nipple i.e. for breast feeding . The diseases affecting the nipple-areola complex can be broadly classified as congenital like (athelia, hypoplastic nipples, extra nipples and inverted nipples), traumatic (including surgical trauma), inflammatory and malignant diseases including Paget’s disease. The most important and most common abnormalities that affect nipples are inverted nipples and Paget’s disease so we discussed them and their management. Inverted nipple, which is defined as a nipple located on a plane lower than the areola, presents both functional and cosmetic problems. It is a source of repeated irritation and inflammation and interferes with nursing. In addition, its abnormal appearance may cause psychologic distress. With consideration of its underlying pathophysiologic components and severity. With consideration of these components of the inverted nipple and its severity, various surgical procedures have been proposed. The ideal procedure for the inverted nipple is simple, reliable, not time-consuming, with low recurrence and no visible scars, requiring no special or bulky dressing, and if possible, preserving ductal function these procedures are: 1. Scar-Free Technique for Inverted-Nipple Correction is a new technique based on the use of two triangular flaps. Compared with other techniques that use triangular flaps, the described technique does not involve areolar skin. Instead, triangular dermal flaps are elevated under the areolar skin, which overcomes the visible scarring issue. 2. Arabesque Shape Sutures for Correction of Inverted Nipple in which a minimal-incision technique supported by‘‘arabesque’’-shape percutaneous sutures. 3. Using 2 V-Y dermoglandular flaps performed in the dermoglandular portion of the nipple. This method is effective in the correction of moderate and severe inverted nipple deformities. 4. Correction of the Inverted Nipple With an Internal 5-Point Star in which release of the fibrosis and retracting ducts with the introduction of a stitch of polyglactin as filling material, performing an internal star suture in only one surgical intervention, without the need for using graft material, or local flaps that introduce scars around the nipple. The technique is simple, with excellent and long-lasting results. 5. Correction of Severely Inverted Nipple with Telescope Method which consists of making a circumferential incision, pulling out the nipple, and tightening the nipple base. With this technique, most lactiferous ducts and parallel sensory nerves that travel through the nipple base are not injured. 6. Correction of Recurrent Grade III Inverted Nipple with Antenna Dermoadipose flap In this technique, dermoadipose flaps were generatedwithin the area of de-epithelialization of mastopexy.The flap is called ‘‘antenna flap’’ because of its designing.