The pathophysiology of the inverted nipple is characterized by
less connective tissue beneath the nipple, dense fibrous tissue
at nipple-areola junction and shortened fewer functional lactiferous
ducts. For grade I and II nipple inversion, the dissection
of dense fibrous tissue at nipple-areola junction is sometimes
not enough to completely bring out the nipple and also the recurrence
rate is high. These findings suggest that the shortened
hypoplastic ducts might play a considerable role in grade I and
II nipple inversion. The purpose of this study was to prove the
effectiveness of partial ductal division and V-Y advancement of
glandular tissue to correct the inverted nipple. Through a 3 mm
slit incision around the nipple base, partial division of lactiferous
ducts was performed and V-Y advancement of parenchyma was
followed. The extent of ductal division was limited only to the
central portion until the nipple protrusion persisted without any
support. A deep purse-string with a 4-0 permanent suture reinforced
the advancement of glandular tissue to add bulk beneath
the nipple, and a superficial purse-string was applied at the
subcutaneous layer to avoid instability of the nipple. 168 female
patients(309 nipples) underwent this procedure from April 2000
to June 2008. 37 nipples were grade I and 272 nipples were
grade II. No major complication occurred. Overall recurrence
rate was 4.2%(13/309). Among 17 women who had breast-fed
after correction of inverted nipples, 2 women failed to breastfeed.
This safe and simple technique can correct almost all
pathologic factors of nipple inversion, and it can also be easily
applied to reoperation cases.