I. Introduction and etiology of nipple invagination
The nipple diameter of oriental women is 8-12mm, the height is 5-10mm, and the areola diameter is 30-34mm. nipple invagination, that is, the female nipple does not protrude from the surface of the areola, or even sunken in the skin surface, local as a crater-like phenomenon. The incidence is 1 to 2%. The degree of nipple invagination may not be the same on both sides, and may occur on only one side.
The general causes of nipple invagination are skin and subcutaneous tissue subsidence, nipple smooth muscle dysplasia, breast duct shortening, and partial tissue fibrosis contracture. The main causes of severe nipple invagination are ductal shortening and tissue fibrosis contracture. The clinical observation of nipple invagination is mostly primary nipple deformity.
Second, the degree of indentation classification and adverse effects
Nipple invagination depth varies can be divided into degrees.
1, mild nipple invagination, nipple neck exists, can be easily squeezed out, and the size of the nipple after squeezing out is similar to that of a normal person.
2, moderate nipple invagination, 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 a nipple neck.
3, severe nipple invagination, the nipple is completely buried under the areola, unable to make the invaginated nipple extrusion.
Three, the adverse effects of nipple invagination include
1, very easy to cause nipple areola inflammation and inflammation of the mammary glands and other diseases.
2, seriously affect breastfeeding.
3, affecting the aesthetics of the breast and the psychological health of the patient.
4. Inverted nipples are difficult to play an effective sexual stimulation, which affects the sexual life of couples.
Surgical treatment
Mild nipple invagination can be treated by non-surgical conservative methods, and the timing of treatment is best chosen before marriage or early pregnancy. Specific methods include.
1.Manipulation and pulling. The teenage period is an important time for breast development and for correcting nipple invagination. Each exercise lasts for 5 minutes, at least twice a day, and the nipples will gradually bulge outward with long-term adherence to treatment. The advantage is that there is no damage to the milk ducts, the disadvantage is that it is difficult to consolidate the efficacy and easy to relapse.
2. Suction therapy. After pregnancy, the nipple is attracted several times a day by applying a suction device, using its negative pressure to induce nipple bulging.
Surgical treatment
Moderate and severe nipple invagination needs to be treated by surgery, which mainly includes the following two types of surgery
1. Nipple Inversion Corrector: a minimally invasive correction method, operated under local anesthesia, the corrector is placed on the nipple surface, pulling the invaginated nipple and lengthening the shortened milk ducts to make the nipple bulge lasting. It is characterized by the preservation of the integrity of the milk ducts, which does not cause breastfeeding disorders; no destruction of the local structural shape of the breast, no obstruction of nipple blood flow, and normal sensation; inconspicuous scar; simple and easy to perform, with fewer complications; easy to wear, does not affect normal life, and allows normal bathing and activities during treatment. The surgery is performed under local anesthesia, and the entire procedure is completed in about 20 minutes. The effect of anesthesia usually lasts about 2 hours, and even after the effect of anesthesia wears off, most patients can still tolerate the mild discomfort after surgery and do not need to take painkillers. The medication is changed the next day after surgery, and the nipple blood flow and sensation are observed, and the tension is adjusted by lengthening or shortening the wire fixed on the stent according to the patient’s condition. The tension will be adjusted by lengthening or shortening the wire fixed on the stent according to the patient’s condition. Generally within 1 to 3 months, the nipple can be corrected, and continue to wear for 3 to 6 months to consolidate the effect.
2, conventional nipple invagination correction: generally under local anesthesia, three to four radial incisions are made in the areola to loosen the fibrous bundle causing nipple invagination, if necessary, cut off part or most of the shortened breast ducts, while transplanting part of the tissue to fill the empty nipple, and create a narrow ring in the nipple neck to prevent the tissue filled into the empty nipple from herniating out. Compared to the nipple inversion corrector, this procedure is complex, with more damage, significant scarring, possible impairment of nipple blood flow and sensation, and affects breastfeeding function. It is suitable for women who have already given birth and are not considering breastfeeding in the future, or for patients with recurrent local inflammation and severe indentation deformity by scar pulling.
Precautions before surgery
1. Do not take drugs containing aspirin for two weeks prior to surgery to avoid bleeding.
2.Patients with hypertension and diabetes should inform the doctor of their condition informatively at the initial consultation.
3.Healthy, no infectious diseases or other physical inflammation.
4. Surgery is not recommended during menstruation, pregnancy or breastfeeding for 6 months.
Precautions and care after surgery
1. Avoid getting water on the wound site for 3 days to prevent infection.
2. Avoid squeezing or traction on the surgical site.