Nipple invagination usually occurs due to congenital development, shortened ducts, partial tissue fibrosis contracture, and poorly developed smooth muscle of the nipple. The main causes of nipple invagination are ductal shortening and tissue fibrosis contracture.
Secondary nipple invagination (acquired nipple invagination) is caused by pulling of the nipple by pathological tissue in the breast or compression by bra or corset. It is most often caused by inflammation, tumor and other diseases that invade the ducts, ligaments and fascia of the breast, causing contraction of the invaded ducts, ligaments and fascia; unreasonable chest binding or wearing too tight a bra occurs in atch adolescence, due to tight chest atch binding, poor blood circulation, resulting in poor breast development and nipple invagination. Zhang Mei, Department of Two Gland Surgery, Shandong Qianfo Mountain Hospital
Clinical manifestations
According to the nipple invagination depth varies can be divided into three degrees.
1, once for partial nipple invagination, nipple neck exists, can be easily squeezed out, after squeezing out the nipple size is similar to normal people.
2, the second degree for the nipple is completely sunken in the areola, but the nipple can be squeezed out by hand, the nipple is smaller than normal, mostly without the nipple neck.
3, the third degree is the nipple is completely buried under the areola, and it is impossible to make the inverted nipple extrude.
Inverted nipples are very likely to cause diseases such as inflammation of the nipple areola and inflammation of the mammary glands, and severe nipple invagination leads to mucosalization of the invaginated skin with eczema. Bleeding and erosion can occur, forming chronic inflammation. The ducts of the mammary glands are connected to the invagination, and the inflammation can spread to the mammary glands and cause mastitis by retrograde infection. If the nipple inversion is not corrected in time, the inflammation is stimulated for a long time, resulting in the contraction of the breast ducts due to chronic inflammation, the nipple inversion is more serious, and a vicious circle is easily formed.
The nipple inversion seriously affects breastfeeding. Whether the nipple is flat or invaginated, it is bound to affect the baby’s sucking, making breastfeeding difficult or impossible after delivery. On the other hand, the inability to discharge milk causes milk accumulation, which may lead to secondary breast infection.
Treatment
1.Manipulation and pulling
Adolescence is an important period for breast development and for correcting nipple invagination. Frequent nipple pulling can make the nipple protrude, extend the ducts, fiber cords and smooth muscles, and make the nipple naturally and gradually bulge outward. However, this requires a longer period of time and is done gradually to obtain good results.
2.Attraction therapy
The principle of action is similar to that of manual pulling, through the negative pressure suction device, the inward nipple is pulled to achieve the purpose of lengthening the ducts and fibrous cords of the breast.
3.Surgical treatment
(1) Brace method of nipple invagination correction So far, this method is the only surgical method that can preserve the function of lactation. The invaginated nipple is fixed to the external brace by steel wire, and after 3-6 months of continuous pulling, the nipple is lengthened and the purpose of nipple invagination is corrected. It is suitable for patients with mild, moderate or severe degree of sunkenness. This method does not require an incision in the skin, does not destroy the breast ducts, can preserve the function of breastfeeding, and also does not affect the sensation of the nipple, and has a low recurrence rate. The disadvantage is that the treatment time is longer and may cause inconvenience in life.
(2) The incision method of nipple invagination correction can be used for women who have given birth and are not considering breastfeeding in the future, or for patients with recurrent local inflammation and severe concave deformity from scar pulling. During the operation, the breast ducts are completely cut off, the sunken nipple is fully loosened, and a tissue flap is designed to fill the tissue defect at the root of the nipple to strengthen the support of the nipple.
The incision method of nipple invagination correction can be completed in one stage of surgery and the treatment time is short. However, the incision method requires disconnection or partial disconnection of the breast ducts, which affects the postoperative lactation function; if the scar on the deep side of the nipple develops contracture, it can cause recurrence of nipple invagination.
Prevention
If nipple invagination is congenital, it is recommended to insist on daily manual nipple traction to lengthen the nipple when the breast starts to develop. Generally, this method is effective in correcting mild to moderate nipple invagination. For severe nipple invagination, it can also provide some relief. For nipple invagination due to secondary causes, it is necessary to actively treat the primary cause, remove the cause of nipple invagination as soon as possible, and create conditions for surgical treatment.