In 2011, a 22-year-old Ms. Huang, who had a family history of nipple depression, came to our department for consultation before she was ready for marriage and family life. At that time, we considered that one of the reasons was the postoperative scar adhesions, and the other was that the depression was more serious and needed more subcutaneous tissue to be filled; after analyzing and clarifying the reasons, we asked her to re-operate six months later to fully release the pulled tissues and design a more appropriate size of subcutaneous tissue flap to fill in the area to make the nipple more upright and more beautiful without increasing the original surgical scar. The customer was also satisfied with our modified surgical treatment.
Based on the report of “nipple indentation” in 2009, it has attracted positive response; now, in view of our many years of experience in the diagnosis and treatment of nipple indentation, we have made a comprehensive improvement in the understanding of the factors influencing the relatively high recurrence rate of true nipple indentation after surgery, improved the corresponding surgical procedure and related treatment, and the recent clinical application efficacy has verified its remarkable We would like to thank you for your trust and support, and for this reason, we would like to introduce a more comprehensive cognition for nipple indentation.
I. Concept
Nipple indentation, or crater nipple, is a common female breast defect in which the nipple is completely or partially below the areola level, with a reported percentage of up to 40%.
Classification and extent
There are two clinical categories in terms of the cause: primary (the causes can be: dysplasia of the smooth muscles of the nipple and areola, underdevelopment of the milk ducts themselves, lack of supporting tissue under the nipple, etc.);
The other category is secondary (i.e., nipple indentation caused by other diseases of the breast, such as malignant tumor of the breast, trauma, scar, etc.); for secondary nipple indentation, which is mostly unilateral, more emphasis is placed on the diagnosis and treatment of primary diseases (e.g., diagnosis and treatment of breast tumor) in order to further strive for improvement of nipple indentation.
This article focuses on the further understanding and knowledge of “primary nipple indentation”, which is currently clinically divided into two types: 1.
1, pseudo nipple indentation, as the name suggests, is a non-genuine nipple indentation, which can be stimulated by pulling, etc., can be self-projected skin surface, nipple appearance as normal appearance;
2, as opposed to pseudo, that is, true nipple indentation: nipple indentation, by simple pulling, stimulation, etc., can not be protruded quite on the skin surface, or retracted into again, the areola may be accompanied by dysplasia, non-surgical treatment can not improve, mostly bilateral, often with genetic factors can be traced (mother, aunt and other women in the immediate family have nipple indentation).
There are 3 types according to the degree of nipple retraction.
Type I: partial nipple invagination, nipple neck exists, can easily squeeze out the nipple by hand, after squeezing out the nipple appearance as normal.
Type II: nipple is completely sunken in the areola, but the nipple can be squeezed out by hand, the nipple is smaller than normal, and most of them do not have a nipple neck.
Type III: nipple completely buried under the areola, unable to squeeze out the nipple.
Third, the impact of nipple indentation on the human body
The main manifestations are the following: a. Because of the invagination, it affects the cleaning of the nipple, which can easily lead to the harboring of bacteria, causing odor, accumulation of secretions, chronic inflammation such as nipple erosion. b. A more important point is that women are responsible for breastfeeding and raising the next generation, and the nipple is the best means of breastfeeding, so if it is invaginated, in addition to affecting the very people who can understand the lack of maternal happiness, it is more likely that c. Affects the beauty of the breasts and lacks the beauty of the curves.
IV. Treatment
According to different etiologies, effective targeted treatment is carried out.
A. Primary nipple invagination is treated with non-surgical or surgical treatment according to the degree.
Non-surgical treatment is mainly used for the treatment of primary pseudo-inflated nipples, and surgery can be used when it is not effective.
(1)Traction
(2) Negative pressure suction
2. Surgical treatment If the non-surgical conservative treatment of nipple invalidation, nipple invagination surgery is feasible (at present, there are various surgical procedures for surgical correction, and our department not only selects the effective surgical procedure according to the actual situation of the patient, but also makes targeted improvements to the surgery, which achieves good results and significantly reduces the chance of recurrence after surgery), and the surgery mainly corrects the causes of invagination: fully loosening the abnormal smooth muscle bundle that pulls the nipple and areola The surgery is mainly aimed at correcting the cause of the indentation: fully loosening the abnormal smooth muscle bundle pulling the nipple and areola, filling the supporting subcutaneous tissue of the nipple appropriately if necessary, in order to achieve the effect of nipple external uplift, and reducing the damage of the milk discharge channel as much as possible to facilitate breastfeeding, while the postoperative scar is not obvious and does not affect the aesthetics of the breast.
Second, secondary nipple invagination should be performed for the cause, such as timely treatment of breast inflammation, trauma, tumor, etc.
V. Prevention and precautions
A. Conventional prevention.
1, after the growth and development of the breast (after about 16 years of age), if it is pseudo-inflation, you can go to the plastic surgery department for consultation and guidance on the correct physical method of operation: hand-pull traction, negative pressure suction and other ways to correct as much as possible, if it is not effective, then surgery can be considered for correction. True depression, it is recommended to find a plastic surgeon to perform the relevant surgical treatment.
2, breast development underwear do not too tight or rough, as far as possible to keep the nipple clean and dry, to reduce the occurrence of mastitis;
B, nipple correction post-operative precautions.
1, adults can be local anesthesia for painless corrective surgery; keep the wound dry after surgery to avoid the occurrence of infection;
2, regular drug changes, one week after surgery, can be removed;
3, after surgery to avoid excessive squeezing nipples, pulling the nipple at the right time, etc.
4. Develop a good sleeping posture and avoid squeezing the nipple.