Inverted Nipple Correction Using a Combination of the Perpendicular Suture Method and the Purse-String Suture Method

Inverted nipple is defined as a state in which part of the nipple or the entire nipple is retracted below the surface of the areola. Inverted nipples can be classified in accordance with Han and Hong’s classification [1] as follows: grade I (mild), grade II (moderate), and grade III (severe). Surgical correction aims to achieve aesthetically satisfactory nipple projection without recurrence, while also maintaining the sensory and lactation functions [2]. Various surgical methods have been suggested for correcting inverted nipples, including dermal and dermoglandular flaps, endoscopic release, internal suturing, continuous traction, and the use of artificial dermis [3-8]. The variety of surgical techniques reflects the difficulty of achieving a satisfactory outcome with any single method. A surgical technique employing 2 horizontal mattress sutures was suggested by Gould et al. [9] in 2015. This is a relatively safe and effective method, but we found that the shape of the nipple base immediately after surgery was angular, and that satisfactory nipple projection was difficult to achieve with time; accordingly, we developed a new method, as described in this report. Using the surgical method of Gould et al. [9] as a benchmark, we surmised that combining this technique with purse-string suturing would produce a better outcome. Thus, we introduce a surgical technique that combines 2 suture-based methods.