Nipple ulcers of the nipple retractor technique to correct inverted nipples: A retrospective multivariate analysis

A simple procedure using a nipple retractor to correct inverted nipples has been applied in clinical practice with stable and satisfactory aesthetic outcomes. Nipple ulceration and necrosis are rare and severe, with the causes unclear.

This study aimed to investigate the risk factors for the development of nipple ulcers in the nipple retractor technique.

A retrospective study was conducted on inverted nipple patients between January 2012 and September 2021. Clinical information, including baseline patient demographics, reproductive history, smoking, previous treatment, nipple inversion grades, nipple size, areola size, blood flow perfusion, and ulcer development, was collected.

Twenty-five female patients with 44 inverted nipples were enrolled. Nipple ulcers were present in seven patients, four of whom were bilateral. Logistic regression analysis showed nipple inversion grades (Z = 2.105, OR 7.005, 95% CI: 1.144-42.898, p = 0.035) and relative perfusion of nipples (Z = -2.337, OR 0.969, 95% CI: 0.944-0.995, p = 0.019) were significantly associated with ulceration. The structural equation model demonstrated the interaction of related factors: nipple inversion grades increased by 0.411 points for ulcers (p = 0.004), while relative perfusion of nipples decreased by 0.647 points for ulcers (p < 0.001).

Preoperative nipple inversion severity and post-operative nipple blood supply may be the risk factors for nipple ulcer development in the nipple retractor technique.