Surgeries for deformities of the nipple-areolar complex

Deformations of the nipple-areolar complex include an inverted nipple, nipple hypertrophy, an areola of too large a diameter, and deformation of the areola in the case of a tubular mammary gland.

• Inverted nipple

An inverted nipple may be congenital, but may also develop after reduction mammoplasty or breast lift. The cause of congenital deformation is underdevelopment of the milk ducts and contraction of the smooth muscles of the areola and nipple. Postoperative change in the shape of the nipple is the result of contraction of the milk ducts due to cicatricial changes in the stalk of the nipple-areolar complex. Quite often, an inverted nipple is combined with hypertrophy of the mammary glands. In any case, the solution to this problem is to intersect the milk ducts at the base of the nipple.

Technique of the operation. A small incision is made at the base of the nipple at the 9 o'clock position on the conventional clock face. The retracted nipple is pulled up with a single-pronged hook, and the ducts holding it are crossed inside the nipple. Then, with the nipple pulled out, a U-shaped suture is applied at its base, located parallel to the access line. The suture is removed 5 days after the operation.

• Hypertrophic nipple

A hypertrophied long nipple can cause serious discomfort to a woman. In addition to the aesthetically unsatisfactory relationship between the mammary gland and the nipple, the patient is often bothered by pain. Chronic trauma to the nipple can lead to its dysplasia and even malignancy. A long nipple can form both with hypoplasia and hypertrophy of the mammary glands. Its length and diameter can reach 2 cm.

Technique of the operation. At a height of 5 mm from the base of the nipple, a circular incision is made on its surface to the muscle layer and ducts. Another circular incision is made 1 mm below the top of the nipple. Excess skin between the accesses is excised, after which the ducts are telescopically repositioned into the base of the nipple and a continuous suture is applied along its entire circumference.

• Areola deformity

An increase in the areola diameter to 10 cm is often observed with hypertrophy and sagging of the mammary glands. However, a decrease in the areola diameter may also be required with normal mammary gland volume, as well as with augmentation mammoplasty.

Reduction of the areola diameter (including during augmentation mammoplasty) is performed using the L. Benelli method.

Technique of the operation. The surgeon circularly excises a section of the areola, after which he applies a continuous intradermal suture with #4/0 prolene around its entire circumference. When tightened, the edges of the skin gather into multiple small folds, which straighten out within a month.

When removing a relatively wide area of skin, the differences in the length of the outer and inner edges of a circular wound become quite significant.

In this regard, even a small rotational displacement of the wound edges relative to each other can lead to the formation of skin folds that persist in the postoperative period.

Prevention of this complication is achieved by applying several radial lines to the areola before surgery, the alignment of which after excision of the skin area reduces the possibility of rotational displacement of the edges of the wound.

Tubular mammary gland. In tubular mammary gland, the contour of the areola is raised above the skin surface, and the goal of the operation is to achieve a single contour of the gland and areola.

Technique of the operation. In the absence of ptosis of the gland, a strip of skin is circularly de-epidermized, which is telescopically inserted into the tissue of the gland. The wound is circularly sutured with a continuous suture.

In case of sagging breasts, this operation is combined with augmentation mammoplasty.

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