Patient's question:
A female colleague in our unit used to have very full and prominent breasts, but recently she has noticed that they have shrunk significantly. She thought it might be due to weight loss. She mentioned that there is a concave area in her breast, and she doesn't know what the reason is. It's quite strange. Could you please explain what might be happening?Doctor's answer:
The breasts must not only have a proper shape and size but also must include nipples and areolas. The nipple is the area where the infant suckles milk, and it is sacred to the mother. Moreover, only breasts with normal nipple and areola size, shape, and position are considered perfect. If a mature female's nipple is concave and retracts below the surface of the areola skin, not protruding above the areola plane, creating a condition where the area appears like an orifice, it is called nipple inversion. The degree of nipple inversion varies; some cases only show retraction of the nipple, while severe cases involve the nipple being concave or even inverted. Nipple inversion not only affects the aesthetic appearance of the breast but also hinders breastfeeding function. The affected area is difficult to clean, and the recessed part can easily accumulate dirt and cause local infections. Since the milk ducts are connected to the, inflammation can spread to the breast tissue, leading to mastitis. Therefore, correction is necessary.Nipple inversion is primarily congenital but can also be caused by trauma, surgery, breast tumors, or fibrosis after mastitis. The main reason for congenital nipple inversion is the underdevelopment of smooth muscle in the nipple and areola. These muscle fibers pull inward, and the lack of supportive tissue beneath the nipple exacerbates the condition, resulting in inversion. Inversion typically occurs bilaterally but can also be unilateral. Mild nipple inversion, also known as correctable nipple inversion, is when the nipple can be gently pushed or pulled back out. This type of inversion can be corrected through non-surgical conservative treatments, with the best timing being before marriage or in the early stages of pregnancy.
Specific methods include manual traction and mechanical traction.
Manual traction: The nipple is manually pushed and pulled out of the skin. The thumb and index finger are used to hold the nipple horizontally or vertically and pull it outward continuously or intermittently for about 30 minutes. Bilateral nipples are alternated, performed 3-5 times daily.
Mechanical traction: A manual or electric breast pump is used to create negative pressure, drawing the nipple out. The same method of continuous or intermittent pulling for 30 minutes is applied, with bilateral alternation, performed 3-5 times daily.
Both methods can yield good results after two months.
In cases of irreparable nipple inversion (severe inversion), surgical correction is the only option. The surgery involves completely releasing the pulling muscle fibers and filling the area beneath the nipple with surrounding tissue to enhance support, lifting the nipple, and reshaping it. The procedure is typically performed under local anesthesia, with various techniques available depending on the specific condition. The surgery is conducted within the areola range, resulting in minimal scarring. Under normal circumstances, it does not damage the sensory nerves of the nipple, so postoperative sensation remains unaffected. The surgery generally does not disrupt milk ducts, thus avoiding breastfeeding complications.
It is worth noting that even after surgical correction, there is a possibility of recurrence. Therefore, after suture removal (5-7 days post-surgery), manual traction should be continued for 1-2 months. Those with the means may also use mechanical traction to consolidate the results and prevent recurrence.