Answer:
Nipple inversion can be congenital or acquired such as after a reduction mammoplasty and is thought to result from either a lack of projection due to a decreased amount of fibrous tissue beneath the nipple or an excessive amount of inward retraction due to shortened breast ducts or tension on a nipple pedicle in the case of reduction mammoplasty. In a woman who acquires an inverted nipple not obviously related to surgery, cancer should be ruled out. Multiple techniques have been described but they all involve everting the nipple outwardly with a hook or suture and using one or a conbination of two general approaches: providing more bulk beneath the nipple or releasing the tissue causing retraction.
One of the simplest techniques described by John Bostwick is based on the assumption that retraction is the primary cause. After placing the nipple on traction, a No.11 blade is used to divide some of the ducts and fibrous tissue at the base of the nipple. The small incision site is then closed with chromic sutures to tighten the nipple base without compromising vascularity.
El Sharkawy (PRS 1995; 95:1111) describes a more elaborate technique which also aims to preserve ductal function. Multiple triangular flaps are created on the areola around the nipple. These flaps include areolar muscle tissue and are mobilized inwardly toward the nipple. The dissection is carried only to the outer circumference of the actual nipple so as to preserve ductal tissue and the nipple’s vascular supply, however, any fibrous tissue encountered is divided. With the nipple on traction, the triangles are sutured together in two layers to create a larger, nipple with greater projection.