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Paraskevas A, Sabri E (2012) A simple and easy technique to correct inverted nipple deformities. Eur J Plast Surg 35(10):759–761 While still attached, the nipple and areola are both lifted from the breast and sewn into a protruding shape. Breastfeeding confers several health benefits to infants and their mothers, including protection from infectious and chronic diseases, improved child cognition, development, and intelligence, and decreased risks of maternal depression and malignancies [ 1, 2, 3, 4, 5]. As such, breastfeeding is recommended as the exclusive nutrition for the first 6 months of the infant’s life, with continuation until 2 years complemented with solid foods [ 6, 7, 8]. However, women with inverted nipples often have difficulties in maintaining breastfeeding due to improper infant latching that my cause insufficient milk extraction and poor infant satiety, thus leading to early termination of breastfeeding. Congenital inversion of the nipple, the most common nipple deformity, is due to early developmental arrest [ 9], with an estimated prevalence of about 10% [ 10]. However, nipple inversion can also be acquired secondary to mastitis, macromastia, carcinoma, or breast reduction, or can be associated with congenital syndromes such as Robinow and MR/MCA syndromes [ 11]. Han and Hong categorized the severity of inverted nipple into three grades. In grade 1, the nipple is easily pulled out manually, maintains good projection, and has minimal fibrosis. Grade 2 includes the majority of inverted nipple cases in which the affected nipple can be pulled out manually but fails to maintain projection and has moderate fibrosis beneath it. Grade 3 constitutes the rarest type of inverted nipples, which cannot be pulled out manually due to severe fibrosis [ 12]. Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT. statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med. 2010;2010(152):726–32.
Nabulsi M, Ghanem R, Abou-Jaoude M, Khalil A. Breastfeeding success with the use of the inverted syringe technique for management of inverted nipples in lactating women: A study protocol for a randomized controlled trial. Trials. 2019;20:737. Nabulsi M, Tamim H, Shamsedine L, Charafeddine L, Yehya N, Kabakian-Khasholian T, et al. A multicomponent intervention to support breastfeeding in Lebanon: A randomized clinical trial. PLoS One. 2019;14(6):e0218467. Park HS, Yoon CH, Kim HJ. The prevalence of congenital inverted nipple. Aesthetic Plast Surg. 1999;23:144–6. https://doi.org/10.1007/s002669900258.
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Pros: What usually looked just flat now fills out readily to the touch or with change in temperature. Initially after treatment, both nipples stay perky. No loss of sensitivity. Very simple to use. KY (2015) Mammography findings of male breast diseases. J Breast Health 11(3):106–110 (Published 2015 Jul 1) The majority of people who suffer from inverted nipples are born with the condition and it can affect both men and women. Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerlć K, et al. SPIRIT 2013 statement: Defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–7.
The World Health Organization. The World Health Organization’s infant feeding recommendation. Available from: http://www.who.int/nutrition/topics/infantfeeding_recommendation/en/. Last accessed 17 Dec 2018. Generally, nipples will evert after 7-10 days of continuous use. After 3 months of continuous use, the inverted nipples are basically corrected, and not easy to get inverted again. Binns C, Lee M, Low WY. The long-term public health benefits of breastfeeding. Asia Pac J Public Health. 2016;28:7–14. Dessena L, Dast S, Perez S, Mercut R, Herlin C, Sinna R (2018) Inverted nipple treatment and poliglecaprone spacer. Aesthet Plast Surg 42(4):958–963
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Riordan JM, Woodly G, Heaton K. Testing validity and reliability of an instrument which measures maternal evaluation of breastfeeding. J Hum Lact. 1994;10(4):231–5. Participants in the control group received standard advice on their infant nutrition, and on treatment of their inverted nipples by their primary physicians. Standard advice on infant nutrition could include exclusive or partial breastfeeding either by direct latching on the mother’s breast, or by using a nipple shield, Niplette™, inverted syringe, expressed maternal milk using a pump, or the use of artificial milk instead of breastfeeding. Outcome measures Alexander JM, Grant AM, Campbell MJ (1992) Randomised controlled trial of breast shells and Hoffman's exercises for inverted and non-protractile nipples. BMJ 304(6833):1030–1032 Inverted nipple is a problem that affects a large number of women, with an aesthetic and functional repercussion. The literature is abundant in terms of techniques described, from the most conservative to the most aggressive. Although different techniques have been described to correct inverted nipples, there are no established algorithms to guide the surgeon in choosing the correct technique for each patient. Therefore, the objective of this paper is to present the first algorithm to simplify the inverted-nipple approach, based on the most recent scientific evidence and the patient’s wishes. Methods
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