Inverted Nipple Correction Techniques: An Algorithm Based on Scientific Evidence, Patients' Expectations and Potential Complications.

Background: Inverted nipple is a problem that affects a large number of women, with an aesthetic and functional repercussion. The literature is abundant in terms of techniques described, from the most conservative to the most aggressive. Although different techniques have been described to correct inverted nipples, there are no established algorithms to guide the surgeon in choosing the correct technique for each patient. Therefore, the objective of this paper is to present the first algorithm to simplify the inverted-nipple approach, based on the most recent scientific evidence and the patient's wishes.

Methods: A bibliographic review on this pathology and available treatments was carried out to build an algorithm. Then, 47 patients consulting about inverted nipple concerns were included in this study. First, the patient's breastfeeding concerns were discussed. Once breastfeeding concerns were known, exploration of inverted nipple and assessment based on the degree of severity was done. Different techniques were proposed according to the degree of inverted nipple. Our technique was indicated in the most severe cases of retraction.

Results: Forty-seven surgical and non-surgical procedures were carried out, resulting in excellent outcomes and high satisfaction rates. No complications or recurrence were observed after 1-year follow-up.

Conclusions: This is the first time an algorithm to simplify the approach of the inverted nipple has been proposed based on the degree of severity and lactation wishes. Choosing the right procedure for each patient will help the plastic surgeon in achieving great satisfaction and an excellent aesthetic result.

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 www.springer.com/00266 .