Surgical Correction of Inverted Nipples

Nipple inversion is a common pathologic condition affecting 2%-10% of women. Congenital inversions are the most common forms, while acquired inversions are less frequent. This condition can induce psychological discomfort, functional problems that could prevent adequate breast feeding, and cosmetic dissatisfaction, and create local irritation and infection. The aim of this article was to provide a comprehensive review of the literature about surgical treatment of inverted nipple.

A literature search was conducted by using PubMed, Google Scholar, and Cochrane database using the following MeSH terms: "inverted nipple," "inverted nipple surgery," "inverted nipple treatment," and "inverted nipple management." Studies that described surgical treatment and included outcomes and recurrence rate were included.

Thirty-three articles were considered suitable, including 3369 inverted nipple cases. Eight studies described techniques with lactiferous ducts damaging, while 25 studies described techniques with lactiferous duct preservation using dermal flaps, sutures, or distractor systems. The average follow-up was 23.9 months. Overall, a satisfactory correction was reached in 88.6% of cases, and the recurrence rate was 3.89%.

To our knowledge, our review includes the largest sample size in the literature. The heterogeneity and subjectivity of outcomes make it more complicated to state which is the best surgical strategy to adopt to obtain satisfactory and stable results with minimal morbidity. This study highlights the need of a standardized method to evaluate outcomes, including aesthetic, functional and psychological results, while using objective and subjective measurement instruments.