NippleNipple, YesmammalThe cylindrical part of the central projection of the breast, compared withAreolaandbreastBe hard.Human female nipples are importantSexy belt, withlactationFunction.The nipple is composed of compactsmooth muscleandconnective tissueform.Smooth muscle is arranged in a circular or radial way when encounteringSexual stimulationOr mechanical stimulation, smooth muscle contraction, can make the nipple become hard and convex.
Before puberty, the nipples of girls will bulge independently.Thereafter, nipple and breast bulge a hillock.With the further enlargement of the breast, the nipple and areola bulge and increase in the breast contour.When the nipples reach the mature stage, most people's nipples are protruding.The nipples of unmarried women and childless women are small. Only after pregnancy, the breast and nipples are affected by estrogen and progesterone in the body of the pregnant woman, and the mammary vesicles and mammary ducts proliferate, the nipples gradually increase and become more prominent, preparing for the feeding of children.The normal nipple is a cylindrical protuberance with holes, about 1cm in diameter and 1.5-2cm in height, dark.
Inverted nipple
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（1） Introduction
Inverted nipple is a common female breast malformation, the incidence of inverted nipple is 1%~2%.The degree of nipple invagination varies from person to person.In mild cases, the nipples are only flat or retracted to different degrees, and may protrude or extrude after being stimulated.In severe cases, the nipple is completely trapped in the areola, unable to be pulled out, in the form of a crater, and often accompanied by secretion or odor.
（2） Etiology
The etiology of inverted nipple can be divided into congenital and acquired, most of which are congenital.The nipple contains the openings of 15-20 mammary ducts, and the periphery of the mammary ducts is surrounded by smooth muscle extending from the areola.The main reason for congenital inverted nipple is the proliferation obstacle of mesoderm during the embryonic development of nipple, which is manifested by the poor development of smooth muscle and mammary duct of nipple and areola, which leads to the failure of ductation of mammary duct and the formation of shortened cord, as well as the shortening of surrounding smooth muscle and fibrous connective tissue, which leads to the lack of supporting tissue under the nipple, plus the inward pulling of mammary duct,The protruding nipple is not obvious or the nipple is invaginated.Acquired nipple invagination is caused by the nipple being pulled by the pathological tissue in the breast. The most common reason is breast cancer, followed by infection, trauma and scar pulling after breast surgery. Occasionally, it is found in the huge sagging breast.
（3） Clinical classification
There are many classification methods of nipple invagination. The most commonly used classification method in textbooks at home and abroad is to divide the nipple invagination into three types according to its depth.Type I (mild): partial inverted nipples exist in the neck of the nipples, which can be easily squeezed out. The size of the nipples after extrusion is similar to that of normal people.Type II (moderate): the nipple is completely sunken in the areola, but can be squeezed out by hand. The nipple is smaller than normal, and most of them have no nipple neck.Type III (severe): the nipple is completely buried under the areola, and the invaginated nipple cannot be squeezed out.
（4） Postoperative complications
1. Incision infection
It is the most common complication of inverted nipple surgery.Because of the disease characteristics of inverted nipple, many patients have infection or chronic inflammation before surgery, and some implants used in surgery may also increase the risk of infection.Before operation, local cleaning and disinfection should be done well, and surgical treatment should be performed after local inflammation is controlled to reduce the incidence of infection. Once infection is found after operation, antibiotics and local incision and drainage should be taken as soon as possible.
2. Nipple necrosis
It is a catastrophic complication of nipple depression correction surgery, which is mainly related to damaged blood supply vessels of the nipple or tight purse string suture at the base of the nipple.The operation should be as careful and gentle as possible to avoid damaging the blood supply of the nipple.Once the nipple necrosis occurs, the necrotic tissue should be completely removed after the boundary of necrotic tissue is clear, and then the nipple reconstruction should be performed after the wound healing.
3. Recurrence
The recurrence rate of nipple depression surgery reported in different literatures is inconsistent, ranging from 3.9% to 10.6%.The main causes of recurrence are: incomplete loosening of the shortened tissue bundle under the nipple, weakness of the supporting tissue under the nipple or traction of the surgical scar.Once it happens, a second operation can be considered 6 months after the operation.
4. Change of areola
It is mainly due to the mobilization of areola tissue to support the nipple during the operation. The shape changes or becomes smaller, which generally does not affect the function. The appearance can be improved by tattooing.
