The inverted nipple: Its grading and surgical correction

Inverted nipples have been treated by various methods by many authors, but the relationship between the grade of the deformity and the appropriate sur gical procedure is not clearly described. One hundred seven inverted nipple s in 60 patients were treated from 1993 to 199?. They were divided into thr ee groups by the authors' system of grading. The grade was made by preopera tive evaluation of severity of inversion and was confirmed by the surgical findings. In grade I, the nipple is easily pulled out manually and maintain s its projection quite well. Grade I nipples are believed to have minimal f ibrosis; thus, manual traction and a single, buried purse-string suture are enough for the correction. The majority of inverted nipples belong to grad e II, i.e., the nipples can be pulled out but cannot maintain projection an d tend to go back again. These nipples are thought to have moderate fibrosi s beneath the nipple. Blunt dissections for surgical release were carried o ut until the inversion did not recur after releasing the traction. The lact iferous ducts could be identified and preserved, permitting proper release of fibrotic bands in the grade II group. The purse-string suture was used. In grade III, to which the least number of inverted-nipple cases belong, th e nipple can hardly be pulled out manually. Severe fibrosis made it impossi ble to reach optimal release of the fibrotic band with the preservation of the ducts. The fibrotic bands are widely dissected, and the lactiferous duc ts are cut, especially in the central portion. Two or three deepithelialize d dermal flaps maybe used to make up for soft-tissue deficiency; a purse-st ring suture is also used. This grading system will be useful for patient cl assification and analysis, systematic planning, and application of the prop er surgical procedures.