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Correction of Inverted Nipples with Fat Grafting : A Novel Technique for a Challenging Problem
Michael Marallo, Erin Anstadt, Carolyn De La Cruz
University of Pittsburgh Medical Center
2021-01-25
Presenter: Michael Marallo
Affidavit:
100%
Director Name: Vu T Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background:
Nipple inversion affects up to 10% of women and is associated with shortened or fibrotic lactiferous ducts and peri-ductal tissue. Surgical release is required for correction in severe cases but there is no consensus on the most effective technique. Here we present a novel approach expanding upon previous methods by combining fibrotic band release, fat grafting, and post-operative stenting.
Methods:
Operative technique: Fat was harvested and processed using the Coleman technique. Nipple papules were everted with tension sutures placed across the base, followed by needle rigotomy of fibrotic bands. Fat was grafted into the potential space created and suspension sutures anchored to a Nipple Shield. At two weeks patients were transitioned to NipletteTM traction devices for four additional weeks. Nipple size, shape, projection, symmetry, sensation, and patient satisfaction were evaluated post-operatively at weeks 1, 2, 4, 12, and roughly 1 year.
Results:
Three patients underwent nipple inversion correction, two with Class III inversion, one with Class II inversion. Mean volume of fat grafted was 8.7 mL. All papules maintained projection (mean 1.0 cm), cylindrical shape, and symmetry with high patient satisfaction in follow-up. One patient reported temporarily diminished sensation post-operatively. No patients required re-operation.
Conclusion:
Nipple inversion recurrence rates are as high as 41%. None of our patients have experienced inversion recurrence. We believe the critical step is grafting larger volumes of fat than previously reported to the potential space created. Risks of this technique include possible sensation changes and transected lactiferous ducts, similar to other reported surgical methods.
