Can Flat Nipples That Were Once Inverted Be Corrected with Surgery?

Dear Galore in Jeffersonville, IN:

The projection of the nipple depends on two things where it is and how big it is.

Most commonly an inverted nipple is a normal nipple that is tethered to the deeper structures. This tethering pulls the nipple back into the breast. So this otherwise normally shaped nipple lacks projection because it is in the wrong location, i.e., pulled down into the breast.

A nipple can also lack projection because it is small or flat. This can occur with out without the nipple being inverted. When it occurs without nipple inversion it is easy to tell; however, nipple inversion can sometimes hide the fact that the nipple is also flat. It only becomes apparent after the tethering is released, and at that point the surprise of having a flat nipple can lead to disappointment.

A non-functional nipple can be reconstructed. This is a completely different operation from inverted nipple repair. Inverted nipple repair is performed for a normal nipple which is hidden in the breast. Nipple reconstruction is done when there is an abscence of a nipple. Most commontly this is done for breast reconstruction after a mastectomy where the nipple has been removed. If nipple reconstruction is done on a normal breast, it is unlikely that you would be able to breast feed. The procedure involves repositioning the skin on the breast to form a projection. I involves additional scarring and the reconstructed nipple may flatten again over time. Several techniques of nipple augmentation also exist, but these need to be discussed indetail on a case-by-case basis.

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Flat nipples that were once inverted can typically be corrected with surgery that will help create scar tissue between the inside walls of the nipple when it is erect. Unfortunately the nipple typically does not become flat after the surgery but instead always stays erect.

Flat nipples that used to be inverted, can probably be corrected further. Usually, inverted nipples can be corrected to erect nipples although some mechanical method to keep them from retracting is usually necessary. You will need to be examined to know for sure but there is a good chance your nipples can be improved.

"Flat nipples" can be corrected with several techniques. One option that is relatively easy in terms of recovery is the use of injectable fillers. Short and long acting fillerrs can be used to increase volume of the nipple and increase projection.  This works reasonably well in most people. Longer lasting solutions can be fat grafting, dermal grafting, or placement of silicone nipple implants. You should be seen by a board certified plastic surgeon in order to find out which is the best option in you.

Depending on the type of surgery you had done, it may be possible to release more of the tethering ducts and increase the protrusion of your nipples.  If the ducts have been fully released, you might just naturally have flatter nipples.  (Over time, even a second surgery to release ducts may result in gradual flattening of the nipples)  Grafts and fillers are sometimes used to increase projection (more often in nipple reconstruction following removal or significant deformity of the natural nipple).    Blood supply to your nipple needs to be considered, since you have already had one procedure.   Be sure to discuss this with a qualified plastic surgeon who examines you and discusses the risks/benefits of additional treatment.

The procedure to correct nipple inversion should result in erect or semi-erect nipples, you may need a revision.

There are several choices for the issue you describe.  You said in your description that you had nipple reconstruction surgery and I'd nned to know exactly what was done to better advise you.  When it comes to giving a flattened nipple more projection I have several cases where I've used fillers.  I have used both Juvederm and Radiesse and I think Radiesse in several cases gave the more desirable result.  I also found that it lasted longer.  I also have cases where I have used GoreTex as a small implant tha is permanent.  In addition I have one case where I have usedfat-transfer for this purpose.  I hope this helps.  Good Luck!  Scott Newman, MD FACS

Direct examination of your breasts will be very helpful to determine the best method to increase nipple projection. If you have additional nipple tissue that can be everted surgically, this would be the simplest surgical technique to use. If you have experienced recurrence of the nipple inversion then further release of the inverted nipples may be necessary. This may involve additional release of lactiferous (milk ducts) that may be tethering the nipples inward.

In the event, that there is no residual nipple tissue to work with, other techniques (such as tissue grafting)  may be necessary to increase the nipple projection. These techniques however are more complicated and complication prone and should not be undertaken unless the “degree of deformity” is of significant concern.

Please consult with a well-trained/experience plastic surgeon to discuss options (as well as the potential risks complications associated with  each option).

It is possible to create erect nipples from flat or inverted nipples. There are a variety of procedures designed to do this. Most of them result in minimal scarring and involve cutting the ducts to the nipple so that breast feeding is generally not possible after the procedure.  Loss of sensation is not usually a problem but loss of projection can be a problem over time.

Although you have had previous nipple surgery, there are still several options to further improve flat nipples.  If the lactiferous ducts were not completely released during your surgery, further surgery may be necessary.  If, however, the nipples simply lack support or volume, this could be corrected with either a fat graft or an injectible filler such as a hyaluronic acid (Juvederm or Restylane), or calcium hydroxyl apetite (Radiesse).