Aesthetic Plastic Surgery

, Volume 43, Issue 2, pp 348–353 | Cite as

Sensation-Sparing Correction of Inverted Nipples Using the ‘Drawbridge’ Flap Approach

  • Bhagwat MathurEmail author
  • Charles Yuen Yung LohEmail author
Innovative Techniques Breast Surgery



An inverted nipple can cause significant functional and psychologic disturbance to women. The holy grail of any surgical technique to correct this is to restore adequate nipple projection and at the same time, try to preserve lactation and nipple sensation. We describe our experience using an inferior dermal nipple-areolar interposition flap to correct the inverted nipple alongside with selective release of the lactiferous ducts of the nipple.

Materials and Methods

We have employed this technique successfully in 97 cases of inverted nipples in 60 patients with follow-up periods of up to 2 years. Twenty-three of them had unilateral inversion, and 37 of them had bilateral nipple inversion.


The appearance of the nipple was good to excellent. Seventy to 80% of the initial postoperative nipple projection at the end of 1 year was maintained. Postoperative complications included stitch abscess in one patient (n = 1) and an epidermal cyst in another (n = 1). Nipple sensation was preserved in 100% of cases. There was no recurrence of inversion in any of the nipples.


By identifying the root cause of inverted nipples in each individual case, and selectively targeting them, we minimize surgical morbidity with a simple technique that avoids any form of traction or compression of the nipple and minimizes the risk of altered nipple sensation.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors


Inverted nipple correction Dermal nipple areola flap Drawbridge flap approach Nipple flap Nipple reconstruction Dermal flap 



The authors acknowledge the work of Mrs. E M W Mithoff, Consultant Plastic Surgeon, Canniesburn Unit, Glasgow Royal Infirmary, Glasgow, UK. None of the authors have a financial interest in any of the products, devices or drugs mentioned in this manuscript.


  1. 1.
    Schwager RG, Smith JW, Gray GF, Goulian D Jr (1974) Inversion of the human female nipple with a simple method of treatment. Plast Reconstr Surg 54:564CrossRefGoogle Scholar
  2. 2.
    Gupta SC (1965) A critical review of contemporary procedures for mammary reduction. Br J Plast Surg 18:328CrossRefGoogle Scholar
  3. 3.
    Han S, Hong Y (1999) The inverted nipple: its grading and surgical correction. Plast Reconstr Surg 104(2):389–395CrossRefGoogle Scholar
  4. 4.
    Scholten E (2000) The classification of inverted nipples. Plast Reconstr Surg 106:737CrossRefGoogle Scholar
  5. 5.
    Cooper AP (1840) On the anatomy of the Breast. Longman, Orme, Green, Brown and Longmans, LondonGoogle Scholar
  6. 6.
    Kehrer FA (1879) Uber Excision des Warzenhofs bei Hohlwerzen. Beitr Exp Geburtshilfe Gynaekol Gizessen 43:170Google Scholar
  7. 7.
    Vorherr H (1974) Chapter 1. In the breast: morphology, physiology, and lactation. Academic Press, New YorkGoogle Scholar
  8. 8.
    Sarhadi NS, Dunn JS, Lee FD, Soutar DS (1996) An anatomical study of the nerve supply of the breast, including the nipple and areola. Br J Plast Surg 49:156–164CrossRefGoogle Scholar
  9. 9.
    Skoog T (1953) An operation for inverted nipples. Br J Plast Surg 5:65CrossRefGoogle Scholar
  10. 10.
    Lamont E (1973) Congenital inversion of the nipple in identical twins. Br J Plast Surg 26:178CrossRefGoogle Scholar
  11. 11.
    Wolfort FG, Marshall KA, Cochran TC (1978) Correction of the inverted nipple. Ann Plast Surg 1:294CrossRefGoogle Scholar
  12. 12.
    Broadbent TR, Woolf RM (1976) Benign inverted nipple. Trans-nipple-areolar correction. Plast Reconstr Surg 58:673CrossRefGoogle Scholar
  13. 13.
    Elsahy NJ (1976) An alternative operation for inverted nipple. Plast Reconstr Surg 57:438CrossRefGoogle Scholar
  14. 14.
    Teimourian B, Adham MN (1980) Simple technique for correction of inverted nipple. Plast Reconstr Surg 65:504–506CrossRefGoogle Scholar
  15. 15.
    Spina V (1957) Inverted nipple. Plast Reconstr Surg 19:63CrossRefGoogle Scholar
  16. 16.
    Skoog T (1965) Surgical correction of inverted nipples. J Am Med Womens Assoc 20:931Google Scholar
  17. 17.
    Sowa Y, Itsukage S, Morita D, Numajiri T (2017) Inverted nipple correction with selective dissection of lactiferous ducts using an operative microscope and a traction technique. Aesthet Plast Surg 41(5):1045–1048CrossRefGoogle Scholar
  18. 18.
    Crestinu JM (1987) The inverted nipple: a blind method of correction. Plast Reconstr Surg 79:127CrossRefGoogle Scholar
  19. 19.
    Hamilton JM (1980) Inverted nipples. Plast Reconstr Surg 65:507CrossRefGoogle Scholar
  20. 20.
    Hauben DJ, Mahler D (1983) A simple method for correction of the inverted nipple. Plast Reconstr Surg 71(4):556–559CrossRefGoogle Scholar
  21. 21.
    D’Assumpcao FA, Rosa EMS (1977) Correcting the inverted nipple. Br J Plast Surg 30:249CrossRefGoogle Scholar
  22. 22.
    Hartrampf CR, Schneider WJ (1976) A simple direct method for correction of inversion of nipple. Plast Reconstr Surg 58:678CrossRefGoogle Scholar
  23. 23.
    Morris AM, Rai YS, Lamont PM (1980) A method for correcting the inverted nipple. Br J Plast Surg 33:41CrossRefGoogle Scholar
  24. 24.
    Jeong JH, Park I, Han J, Park JU (2018) Correction of inverted nipples with the double-track sun-cross running suture technique. J Plast Surg Hand Surg 52(2):87–93CrossRefGoogle Scholar
  25. 25.
    Liang W, Zhao Z, Liu S, Gu T (2017) Cross vertical mattress suturing with basilar tightening during the correction of inverted nipple in 30 cases. Aesthet Plast Surg 41(4):782–787CrossRefGoogle Scholar
  26. 26.
    Haesekar B (1984) The application of de-epithelised turn-over flaps to the treatment of inverted nipples. Br J Plast Surg 37:253CrossRefGoogle Scholar
  27. 27.
    Elsahy NJ (1977) An alternative operation for inverted nipple. Plast Reconstr Surg 57(4):438–441CrossRefGoogle Scholar
  28. 28.
    Brent B, Botswick J (1977) Nipple areola reconstruction with auricular tissue. Plast Reconstr Surg 60:353Google Scholar
  29. 29.
    Feng R, Li W, Yu B, Zhou Y (2018) A modified inverted nipple correction technique that preserves breastfeeding. Aesthet Surg J. Google Scholar
  30. 30.
    Yukun L, Ke G, Jiaming S (2016) Application of nipple retractor for correction of nipple inversion: a 10-year experience. Aesthet Plast Surg 40(5):15–707CrossRefGoogle Scholar
  31. 31.
    Terrill PJ, Stapleton MJ (1991) The inverted nipple: to cut the ducts or not? Br J Plast Surg 44:372–377CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  1. 1.St. Andrew’s Centre for Plastic Surgery and BurnsChelmsfordUK
  2. 2.St Andrew’s Centre for Plastic and Reconstructive SurgeryBroomfield HospitalChelmsfordUK
  3. 3.Center for Vascularized Composite Allotransplantation, Department of Plastic SurgeryChang Gung Memorial HospitalGueishan, TaoyuanTaiwan, ROC

Personalised recommendations