Correction of the severely inverted nipple: areola- based dermoglandular rhomboid advancement.

Inverted nipple is a relatively common aesthetic problem presenting to a plastic surgeon. Along with the functional problems; recurrent inflammation/infection and an inability to nurse, most patients seek intervention because of the abnormal appearance. Many different surgical techniques have been described, suggesting that no one technique is universally successful. Most techniques employ, either individually or in combination, methods to tighten the nipple base or the use of areolar dermal flaps to support the nipple. We propose two modifications to the dermal flap technique. Firstly, the rhomboid dermal flaps are designed solely on the areola, the bases directed peripherally, improving vasularity and allowing true medial advancement. Secondly, the lactiferous ducts and tethering fibrous bands are released in a conical fashion allowing closure with a vertical V-Y advancement. This gives better projection and support to the nipple proper with medial recruitment of glandular tissue closing the dead space created. This technique has been used successfully by the senior author in 20 patients over a 16 year period, with a high rate of preserved nipple evertion and patient satisfaction. The technique is simple, reliable and provides sustained results over long term follow-up for the correction of the more severely inverted nipple.