Inverted Nipple in Toronto, North York, Oakville and Scarborough

What is inverted nipples?

Inverted nipple is a condition where one or both nipples are pointed inward instead of outward, even when stimulated. This condition occurs both in men and women for a variety of reasons.

In the case where this occurs in women, inverted nipples could cause difficulty or failure to breastfeed. Other signs could include irritation or inflammation

There are many different structures and forms of inverted nipples due to:

The amount of fibrosis (connective tissue) beneath the nipple varying from person to person
Present or lack of soft tissue
The state of the lactiferous ductus (ducts that carry milk to nipple)
Scarring and infections

There are three different degrees of inversions classified in grades:

Saline-filled implants

Most women receive saline-filled implants which consist of a silicone shell filled with sterile salt. This type of implant is generally less expensive.

Cohesive silicone gel-filled implants

Recently, new cohesive silicone gel implants have become available to Canadian plastic surgery patients. Silicone gel implants tend to feel more like real breast tissue than saline implants and do not ripple or fold as much as saline implants. The current cohesive gel is less likely to seep, run or shift unlike the older type of liquid silicone implants. The silicone implants have two popular subtypes which are the “Round implants” & the “Tear Drop anatomical implants”.

Silicone Gel implants

With advancement in technology daily, new implants are been still invented under the silicone gel implants. Dr. Hong’s expertise in breast augmentation surgeries is remarkable from performing hundreds of breast augmentation surgeries with great artistic skills. His professional & passionate skills can help you achieve your prospective breast augmentation goals. You need a highly skilled and efficient plastic surgeon to give you your desired rejuvenated figure and Dr. Colin Hong is one of the top plastic surgeons in Toronto.

What causes inverted nipple?

Nipple inversion could occur due to being born with it, genetics, pregnancy, physiological changes of the breast (i.e. drooping), trauma, cancer, infections and other diseases.

What to expect before surgery?

Women who are considering to have surgery done to correct the structure of their nipple must be aware that they may no longer be able to breastfeed. Dr. Colin Hong will further discuss with patients on the nature of the procedure, potential risks and side effects, expected results and recovery process in greater detail during appointments before surgery.

What occurs during surgery?

In general, a small incision is done at the lower portion of the nipple and a sophisticated pattern of stitches (purse-string suture) is conducted to support the nipple, thus correcting the nipple’s shape. The patient is under anesthetics during the procedure. Markings are done before surgery begins to highlight the target areas where the incisions will be made.

To meet the demands of the different types of inverted nipples, grade (I,II,III) and pigmentation of the skin of the patient is considered when choosing which technique is most suitable to use. Dr. Colin Hong will assure to make the right decision to produce the most optimal and desirable results for the patient.

For mild conditions, the milk ducts are stretched (non-incisional) and for grade II, the lactiferous ducts are preserved but the fibrosis are released until the desire projection is obtained

For more severe cases, the milk ducts are divided with the release of fibrosis and the purse-string suture is used as well.

There are many other alternative techniques used for fixing the inverted nipples. Some of the recent different types of technique used are:

Antenna Flap Technique
This technique caters to the grade III case. The dermadipose flaps (the skin located under the nipple) is stripped, this process refers to de-epithelialization area of the mastropexy.

The fat tissue and dermis beneath the first layer of the skin is exposed and then removed. An implant is placed inside the created pocket of the submuscular space and then stapled. After healing, the second part of the surgery can begin. The staples are removed and another pocket was made for the antenna flaps underneath the nipple. Tissue beneath the nipple and lactiferous is dissected and the fibrosis is released. Then the antenna flaps are placed inside the created pocket.

Lastly, a purse-string fashion suture was used to close the incision. This technique is only available for patients who are candidates for mastroplexy.

1. Twisting and locking technique

This technique caters to all grade cases (except for patients with light coloured areloa or an arelora with a small diameter).

A. A diamond-shaped pattern are carefully measured and marked on the areolar, which later on turn into diamond-shaped flaps after de-epithelialization (B)
C. A tunnel is created underneath the nipple by fibrotic bands.
D. The elevated dermal flaps go through the tunnel then is pulled out
E. Dermal flaps are stitched to the opposite side of the de-epithelialization area.
Potential risk: Discolouration of the arelora

Triangular areolar dermal flaps technique
Ideal for grade II cases.
A&B: Two triangle patterns are marked, used to make the incision and create the areolar dermal flaps after de-epithelialization of the triangle area. The triangles are 1mm shorter than the diameter of the nipple.
C: The nipple is pulled out to allow the removal of the fibrous tissue and afterward, both the areolar dermal flaps are pulled with a suture through the slit where they cross.
D: Further stitching is done to attach the structure with the lower dermis of the nipple. Lastly, the area is closed up and the sutures are removed.
Potential Risk: Minimal scars

Internal 5-point star suture technique
This technique is ideal for grade III case. This technique consists of using autologous or heterologous material. The effect of using this material provides the nipple of the appearance of having more volume and projection. The nipple is pulled out, fibrosis is realized, polyglactin is introduced as a filling material and a internal star suture surrounds the nipple.

Nipple Retractors
A suture is used to elevate the nipple causing it to project outwards. The suture is anchored to the areola skin with empty needles. The nipple is then surrounded and coated with a material consisting of cotton gauze and paper tape. The material is taken off after 6 months. It is clinically significant in treating mild cases of inverted nipples.

What occurs after surgery?

This is an outpatient procedure meaning that the patient is not required to stay overnight at the hospital and may leave a few hours after the surgery.

Patient should expect to feel pain, swelling, soreness, and sensitivity around the area of their nipple. Such discomforts should subsidize in a couple of days. Overall, recovering time for the procedure could last up to a week or more, dependent on the individual.

Dr. Hong is a gifted plastic surgeon who enjoys a reputation as a leading edge arm lift, buttock lift, thigh lift, and liposuction Toronto specialist. His reputation includes being a highly knowledgeable tummy tuck Toronto doctor. Please review the following pages to discover more about these surgeries.

Frequently Asked Questions

Choosing your desired implant for surgery depends on quite a number of multiple factors which include your native breast dimension (height and width) , projection, rib cage width, body anatomy, volume, the thickness of tissue, how you want the breast to look like after surgery. The most effective way of choosing implant size is to try out sizers from your surgeon while wearing a tight body fit.

In cases of implant weights, the bigger the implants the more they will likely weigh. The size of 100 cc silicone implant generally weighs 0.23 lbs while that of the saline implant with size 100 cc weighs 0.21 lbs. Going bigger in size, a 300 cc silicone implant weighs 0.69 pounds and a pair weighs 1.38 pounds. 300 cc saline implants weigh 0.63 lb and a pair weighs 1.26 lbs. In this case, implants weigh almost the same as the exact amount that an actual breast tissue would weigh. 

In most cases, the weight varies slightly depending on the manufacturers. There might be a slight weight variation from different manufacturers.

Whether or not a person performs a breast augmentation, the genetic makeup of the individual has a major role to play in the contribution of breast sag. Factors such as weight (increasing or decreasing), gravity, age, skin elasticity & ethnicity have a lot to do when it comes to breast augmentation sagging. In this case, use a very good supportive bra that will help you to reduce the effect of sagging.

The lifespan of breast implant is not actually guaranteed as it is not predictable when the implant lifecycle will eventually end. In which case, no matter how your counseling process has been with your surgeon before the operation, always bear in mind that you cannot have a breast implant that will last a lifetime. 

There is no set expiry date attached to breast implants because there has not been a reason to get them replaced unless there is a possible rupture or have other problems. Most times implants exceed more than 12 years and even last up to 30 years in some cases.  

There are quite a number of new implants that have been introduced for breast augmentation and are known as “jelly bean”, “gummy bear”, or “highly cohesive gel” implants that are also available for breast augmentation and they have a firmer feeling, but there are no effective long term results to indicate that they are much better or tend to last longer than the saline or silicone implants.  

Breast augmentation is normally performed in our Accreditation of Ambulatory Surgery Facilities. It also has certification by the College of Physicians and Surgeon OHP program.

Since the surgery is under general anesthesia, there is no pain during the procedure. 

The greatest period of discomfort for the patient is usually the first twenty-four to forty-eight hours after breast augmentation surgery. Afterward, pains will reduce and there will be no need for too much pain relievers as usual. We do a 24-hour recovery routine that most patients have a very little discomfort after 24 hours. In the case where breast implants are placed in the submuscular position, there will initially cause more discomfort than when it is placed in the subglandular pocket ( in front of the muscle).

In the case of breast augmentation, general anesthesia is commonly used. This will guarantee a painless procedure and also the surgeon can concentrate to deliver his best surgical result. 

You can see pre and post-operative result in our office.

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