Pittwater Life January 2024 Issue

Health & Wellbeing
with Dr John Kippen
Health & Wellbeing
Inverted nipples procedures
Generally, the more severe
the retraction the more
invasive the procedure
needs to be to correct it. There
is a chance that breastfeeding
is not possible; with severely
retracted nipples, the inability
to attach during breastfeeding
may in itself preclude feeding.
Inverted nipples are a
common condition affecting
approximately two per cent of
women. Interestingly, both men
and women can be affected.
One or both sides may be
involved and often unequally.
Instead of pointing outwards,
the nipples appear flat, or as
a depression or slit. Usually
first noticed at puberty with
breast growth and development.
Nipples may be retractile
in that they invert at times and
protract at other times. They
may be permanently inverted.
Functionally, inverted nipples
may be associated with rashes,
irritation and discomfort.
Though often quoted as being
a problem, breastfeeding may
still be possible. Nipples often
spontaneously evert or correct
at the time of breastfeeding.
The correct technique of
attachment with the infant attaching
to both the areolar and
nipple allows adequate breast-
feeding. Correction of inverted
nipples may be for functional or
cosmetic reasons.
There are many causes of
nipple inversion. The breast
has between 12 and 20 ducts
that open independently onto
the nipple. Shortening of these
ducts or fibrous tissue between
the ducts may cause shortening.
Breast scars, underlying
breast disease, breast duct
infections and internal fibrosis
may all cause inversion. Mostly
no obvious cause is found. A
full medical breast and general
history and examination is
necessary to exclude these
reversible causes and exclude
any diseases. The examination
includes the axillae or armpit.
Correction may be non-surgical
or surgical. Non-surgical
methods include massage,
stretching, suction cups or
piercing. There are two main
groups of surgical procedures.
The first preserves breast ducts
and the second cuts through
these breast ducts.
Through small incisions,
the fibrous tissue between the
breast ducts is removed. Skin
flaps and sutures then lift and
hold the nipple in an everted
or protracted position. More
severe cases may need the
breasts ducts to be cut. Deeper
tissue may be lifted and moved
as flaps to push up the nipples
from below.
Our columnist
Dr John Kippen is a qualified,
fully certified consultant
specialist in Plastic and
Reconstructive surgery.
Australian trained, he
also has additional
Australian and International
Fellowships. He welcomes
enquiries; email
doctor@johnkippen.com.au
54 JANUARY 2024
The Local Voice Since 1991