A new surgical procedure for the very severe inverted nipple

Severe cases of inverted nipple usually cannot be corrected by a simple pro cedure, especially if the nipple cannot be pulled out above the areolar lev el by manipulation. We describe a new method for these cases and we classif y the inverted nipple into 3 grades following the choice of their required operative procedure. Our classification for inverted nipple is as follows. Grade I: The inversion is corrected simply by manipulation; the nipple prot rusion is long-lasting. Grade II: The inversion can be corrected by manipul ation, but recurrence of the inversion is frequent. Grade III: The inversio n cannot be corrected without a surgical procedure. Cases of Grades I and I I can be corrected by conventional simple surgical procedures. But some cas es of Grade II and almost all of Grade III cannot be corrected by conventio nal methods, in spite of the high frequency of relapse. Cutting of the lact iferous duct, such as the Pitanguy and Broadbent methods, can correct the v ery severely inverted nipple. But if we want to maintain the lactiferous fu nction after correction, we had better not cut the lactiferous ducts. Our n ew procedure for correcting very severe cases can keep the lactiferous func tion after correction without any relapse. In order to avoid the recurrence of nipple retraction and to maintain the lactiferous function, the new sur gical procedure that we performed makes an incision deeply and vertically o n the nipple to free the lactiferous ducts from the contracted tissues surr ounding them. After extension or resection of the restricting tissues, the nipple is raised easily. This procedure will preserve the feeding function and prevent the recurrence of nipple inversion. For very severe cases, usin g a dermal flap inserted into the base of the nipple may be necessary due t o its role of interposing tissue to prevent reverting to inversion.