Fig 1.
A schematic diagram of the design of the method for inverted nipple correction.
Full-thickness subcutaneous triangular flaps are designed as shown in the diagram after pulling out the inverted nipple. The red dotted circle means the base of the nipple before traction. 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. After traction of the inverted nipple, the circular area of the nipple base becomes larger. The long axis of the triangular flap is equal to the diameter of the nipple base (BB’ = B’A’ = A’A). 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 tip of the opposite triangular flap, B, is then fixated to A’, to which C and C’ are approximated.
Fig 2.
A schematic illustration of the bilateral de-epithelized subcutaneous triangular flaps.
The triangular flaps, except for the bases, are incised down to the breast parenchyma (blue lines). Subcutaneous tunneling is performed below the level of the areolar floor by vertical blunt dissection (bidirectional arrows).
Fig 3.
The triangular flaps are rotated 90 degrees and then crossed through the vertical slit.
The red dotted line and the circular line at the nipple base are incised down to the upper dermis.
Fig 4.
A schematic illustration of the postoperative view.
Fixation is completed by filling the space under the nipple in the vertical direction. Re-draping of the nipple skin and surrounding areolar skin is also performed.
Fig 5.
A postoperative cotton stent made from a finger-rolled stockinet and hypoallergenic nonwoven adhesive tape (Fixomull, BSN Medical, Hamburg, Germany) is worn for two months.
Fig 6.
A 33-year-old patient with Grade II inversion.
(a) Preoperative view of the left breast. (b) Intraoperative view of the de-epithelized triangular flaps. (c) Postoperative view at seven days.
Fig 7.
A 28-year-old patient with grade III inversion.
(a) Preoperative view. (b, c) Surgical design and immediate postoperative view. (d) Postoperative result at seven months.
Fig 8.
A 51-year-old patient with grade III inversion.
(a) Preoperative view. (b) Postoperative result at 17 months.
Table 1.
Various deepithelized triangular flaps for correction of inverted nipple8.