Case 1

                       Before                                                   After
Case 2

                        Before                                                  After

Normal nipple is in protruded position. In an inverted nipple, the nipple is ‘pulled-in’ or retracted. Inverted nipple occurs when there is a pulling force beneath the nipple that pulls the nipple inwards. The causes are usually congenital, post-trauma, lactation or pregnancy. However, if the inverted nipple occurs suddenly over a short period, the cause may be due to underlying breast disease and prompt consultation with a doctor is warranted. 

The patient may feel embarrassed due to the abnormal appearance of the inverted nipple. Inverted nipple also affects the overall aesthetic appearance of the breast. Besides, an inverted nipple can interfere with breastfeeding. Hygiene of the nipple may be difficult to maintain due to the accumulation of dirt, leading to chronic infection and inflammation.

Treatment of an inverted nipple is by surgical correction.

Preparation

1.    Inform the doctor of any pre-existing medical conditions and drug allergy. All medical conditions must be treated and stabilized before surgery.

2.    Stop smoking at least one week before surgery. Smoking negatively affects wound healing and increases the risks of other post-operation complications.

3.    Stop the following one week before surgery:

a.    All supplements that contain vitamin E, ginseng, ginkgo, garlic, fish oil and other ingredients that increase bleeding during surgery

b.    Medicine that increases bleeding during surgery such as aspirin, NSAIDs and warfarin. However, you may need to consult your physician who prescribed the medicine before you stop them.

4.    On the day of surgery, wear simple and comfortable clothing. Do not wear any jewelry and metal objects on the face and body.

Surgery

Duration: one hour

Anaesthesia: Local anaesthesia

Hospitalization: Not required

Recovery*: Back to work the next day, light exercise after one week, heavy exercise after 3-4 weeks.

Technique: Small incisions are made around the nipple to release the tethering tissue bands. Sutures are placed to maintain the nipple in the corrected position. In severe cases, tissue graft may be needed to reinforce the base of the nipple to prevent the nipple from inverting again.

Post-operative Care**

1.    What to expect: Swelling usually peaks on second to third day after surgery and gradually subsides thereafter. Post-operative pain usually is minimal.

2.    General care

a.    Apply cold pack first 3 days and warm pack thereafter.

b.    Avoid smoking for at least one month. Smoking increases the risk of wound complications.

c.    Good rest and sleep can help the wound to heal faster.

d.    Sleep on the back. Avoid sleeping on one side to prevent pressure on the nipple.

e.    Be relaxed and calm, as unnecessary anxiety and worry will slow down recovery. Contact the clinic if there are any queries.

3.    Medicine: Finish the oral antibiotics as prescribed. Take the painkiller as prescribed when necessary.

4.    Wound care: Clean the wound with a clean cotton tip with sterile water/saline and apply antibiotic ointment thereafter.

5.    Physical activity: Avoid heavy physical activity and exercise for at least one month.

6.    Follow-up: Come back one week after surgery for suture removal and review.

7.    Emergency: If there is heavy bleeding, rapid increase in swelling or severe pain, immediately contact the clinic/doctor for advice.

**The instructions in this section are not meant to be exhaustive and are only for general references. If you have any specific queries or concerns during the post-operative recovery, please contact the clinic for further advice.