Retracted/Inverted Nipple Gallery

A woman in her early 40’s who had breast augmentation with us 9 years ago, combined with correction of an inverted (retracted)  nipple.  She has smooth, round silicone gel implants placed partial sub-pectoral( below the muscle)  through an inframammary incision,,  and is still thrilled with the natural, beautiful look of her breasts after surgery.  She has maintained her correction of the inverted nipple which was treated with a micro-incision technique to release the tethered nipple ducts.

A woman in her late teens who is bothered by inverted nipples . She has the most severe category of nipple retraction and would be considered Han and Hong grade III: “ The nipple is severely inverted and retracted. It is very difficult to pull the nipple out manually”
Many different methods have been described for correction. What has worked well in my hands is a micro-incision technique . The severely retracted nipple has ducts which are short and retracted, with a lack of soft tissue. The tethered nipple ducts are released with a microinciision using a special instrument and then held out to length with a special stent. In this way we can avoid buried sutures and dermal, connective tissue or skin flaps. She is shown before and again, 6 weeks after correction under local anesthesia in the office.

An 8 year follow-up on a woman who had correction of a retracted nipple on her left side. She was bothered by having retraction of the nipple for more than 25 years. She was able to manipulate this and bring it out to breast feed her children, but was bothered by the appearance. She would be considered a Han and Hong grade II- With a grade I the nipple can be pulled out easily and maintains its position without traction. A grade II can be pulled out manually, but not quite as easily as a grade I and has difficulty maintaining its position. A grade III is severely inverted and cannot be pulled out manually.
She had micro-incision procedure for release of the retracted nipple in the office with a stent placed for one week and protective pads worn for 6 weeks after her procedure. She was seen for another reason in the office today and is still thrilled to have a normal nipple prominence.

A mother of one in her later 20’s who is bothered by inverted (retracted) nipples. Her right side was moderate and her left side severe according to the classification of Han and Hong. According to Han and Hong, mild or grade I retraction is where the nipple can be pulled out easily and maintains its projection without traction. Moderate or grade II is when the nipple can also be pulled out manually, although not as easily as with grade I and has difficulty maintaining its position with a tendency to retract. Severe inversion, or grade III the nipple is difficult to pull out manually. Nipple retraction is caused by short and retracted milk ducts. To correct this, these ducts are divided under local anesthesia with a special blade through a micro incision and held out to length temporarily with a traction suture while healing is taking place.
She had initial correction with the micro-incision technique under local anesthesia in the office. Although it is rare, she did not achieve satisfactory correction with the first procedure and continued to have some retraction. We returned when she was available for surgery 10 months later and she had a second micro-incision technique on each side. She is shown now at 6 weeks after this second procedure, and has maintained a normal nipple projection. She is happy to “feel normal” again and “confident” about the appearance of her breasts after correcton.

A mother of 2 in her early 50’s who is bothered by a deflated appearance of her breasts after pregnancy, and is also bothered by inverted nipples. She wanted a full but still natural look and selected a 375 cc size. She is shown before and again, 6 weeks after bilateral partial sub-pectoral breast augmentation with a dual plane placement of 375 cc high profile textured silicone gel implants placed through an inframammary incision. High profile was chosen to restore some of her lost upper breast fullness. The pros and cons of texture were discussed and a textured implant with the least aggressive texture was chosen to decrease the potential lateral shifting of the implants with time. A Keller funnel was used to place her implants along with antibiotic irrigation and nipple shields to decrease her risk of biofilm contamination, subsequent capsular contracture and possible BIA-ALCL A micro-incision release of the inverted nipples was performed at the time of her breast augmentation. It has been just 6 weeks since her surgery and we can expect the breasts to “settle” and appear even more natural over the next 4-5 months.

A woman in her later 50’s who has always been bothered by retracted nipples, also called inverted nipples. The severity of nipple retraction has been graded by Han and Hong as Grade I: the nipple can be pulled out easily and maintains its projection well without traction. Grade II: the nipple can be pulled out but not as easily as grade I and it has difficulty maintaining its position. Grade III: severely inverted and retracted, and is very difficult to pull out. The nipple ducts are shot and severely retracted and are pulling in on the nipple like the lines on a parachute. In this patient’s case she was Grade III on her right, and Grade II on her left.
She is shown before and again, 6 weeks after closed treatment of the inverted nipples through a micro-incision procedure performed under local anesthesia in the office. She is thrilled to have normal looking nipples for the first time in her life. Her nipple sensation remains normal

A mother of 2 in her mid 30’s who was bothered by a deflated appearance of her breasts after pregnancies as well as by an inverted nipple (retracted nipple) on her left. Nipple inversion is caused by tight breast ducts that pull the nipple in like a parachute cord. Nipple retraction has been classified by authors Han and Hong into three groups, I, II and III based on the severity of the inversion and fibrosis. A grade I nipple can be pulled out easily and maintains its projection without traction. A grade II nipple can also be pulled out manually but not as easily as the grade i and has difficulty maintaining its position, having a tendency to retract. A grade III nipple is difficult to pull out manually and usually requires a traction suture to resist the forces of fibrosis pulling it back in. This patient had a grade II to III nipple on the left. She is shown before and again, 8 months after bilateral breast augmentation and a closed inverted nipple correction using a micro incision technique. A tattoo has been blurred for her privacy. The photos are otherwise untouched.

A mother of 2 in her early 50’s who has been troubled by inverted nipples (retracted nipples) since her breast development. She is shown before and again, 6 weeks after closed inverted nipple treatment through a micro incision in the office under local anesthesia. The crusting and irritation of her nipples has resolved, and they have regained a normal appearance. Her nipple sensation remains intact.