Nipple Depression Correction: 2 New Suture Techniques for Lasting Results
Introduction
Correcting nipple depression in patients with plasma cell mastitis (PCM) has long been a challenging endeavor with conventional methods often result in suboptimal outcomes, including high recurrence rates and cosmetic imperfections. However, a recent study by Xu et al. (2023) introduces two innovative surgical techniques— the “-” suture technique and the half-pocket suture technique— that provide promising solutions to these issues. Based on their clinical experience and research findings, these techniques offer significant improvements over traditional methods. This article explores the details of these techniques, drawing from their findings, and highlights how they enhance both the structural support and aesthetic outcomes in correcting nipple depression, while reducing the risk of recurrence.
Understanding Nipple Depression in PCM
Nipple depression, characterized by the inversion or retraction of the nipple into the areola, is both a symptom and a complication of PCM. This condition disrupts the shape and tissue integrity of the breast, exacerbating PCM’s severity and increasing recurrence risks post-surgery. Standard correction methods often fail to maintain long-term nipple eversion, leading to relapse and patient dissatisfaction.
Why Does Nipple Depression Happen?
Understanding the etiology of nipple depression is key to selecting the most appropriate corrective technique.
Congenital Factors
Some patients are born with inverted or retracted nipples due to:
Shortened or fibrotic lactiferous ducts that tether the nipple inward.
Weak structural support around the nipple base.
Acquired Causes
Conditions such as PCM and other chronic breast inflammations can lead to:
Scarring and fibrosis of the ducts or surrounding tissues, pulling the nipple inward.
Granuloma formation or abscesses causing structural damage.
Recurrent inflammation weakening the skin and connective tissue integrity.
Post-Surgical Complications
Inadequately treated nipple depression or scarring from previous surgeries can exacerbate the inversion.
The Limitations of Conventional Techniques
Traditional corrective surgeries, such as the oil yarn traction valgus method, involve manual eversion of the nipple using traction techniques. While these methods can temporarily correct the depression, recurrence is common. The underlying structural issues contributing to nipple inversion are not adequately addressed, resulting in compromised results over time.
The 2 Techniques of Nipple Depression Correction
Recent advancements in nipple correction addresses the root causes of depression, offering structural reinforcement and a stable outcome. Two key techniques are gaining prominence: the “-” suture technique and the half-pocket suture technique, each tailored to specific clinical presentations. These techniques prioritize precision and symmetry, ensuring the nipple maintains its natural aesthetic while reducing the likelihood of recurrence. Let’s break down the two primary techniques and how to perform them effectively.
I. “-” Suture Technique for Well-Developed Nipples
This method is ideal for patients whose nipple structures are intact but depressed due to tethering or mild fibrosis. This approach involves everting the nipple and performing sutures on either side of the nipple root. The suture pulls the nipple outward, maintaining its everted position, thus providing structural support and significantly reducing the risk of retraction.
Step-by-Step Guide
Preparation and Assessment:
Evaluate the degree of depression and the nipple base’s structural integrity.
Ensure aseptic preparation of the surgical area.
Eversion of the Nipple:
Manually evert the nipple using a sterile instrument, exposing the root.
Suture Placement:
Use a non-absorbable suture (e.g., 4-0 polypropylene).
Insert the suture on either side of the nipple base, creating a horizontal “-” pattern.
Ensure the suture traverses the deeper layers of the dermis for added stability.
Securing the Suture:
Gently tighten the suture to pull the nipple outward, maintaining eversion. By gently tightening and securing the suture, the nipple is brought into a stable, outward position, minimizing the risk of retraction.
Knot securely, avoiding excessive tension that could compromise the nipple's blood supply.
Post-Operative Care
Monitor for signs of ischemia or infection.
Advise the patient on nipple care to promote healing and maintain results.
II. Half Pocket Suture Technique for Imperfectly Developed Nipples
In cases where the nipple is underdeveloped or overly short, a half-pocket suture is employed. This involves creating a semicircular suture around the nipple base, gradually tightening it to achieve eversion. For cases of hyper-short nipples, partial fibrous tissue at the root is released to allow elongation before securing the suture.
Step-by-Step Guide
Preparation and Assessment:
Assess the degree of nipple underdevelopment and identify fibrotic tissue at the root.
Prepare the surgical field under sterile conditions.
Creating the Pocket:
Make a semicircular incision around the nipple base, extending slightly into the areola.
Carefully dissect the fibrotic tissue tethering the nipple downward.
Placement of Half-Pocket Suture:
Position a non-absorbable suture in a semicircular fashion along the pocket edge.
Begin at one end of the pocket, threading the suture through the dermis and subcutaneous tissue.
Eversion and Securing:
Gently evert the nipple while tightening the suture, ensuring symmetry and stability.
Knot the suture securely, allowing the pocket to hold the nipple in an elevated position.
Addressing Hyper-Short Nipples:
For severely shortened nipples, carefully release the fibrous attachments at the root.
Elongate the nipple before applying the half-pocket suture.
Post-Operative Care
Provide detailed instructions on wound care and scar management.
Schedule follow-ups to monitor tissue healing and nipple positioning.
Why This New Approach is More Effective
This advanced approach addresses several limitations of conventional methods:
Enhanced Stability: The suture-based techniques provide a robust framework to maintain nipple eversion, even under tension.
Reduced Recurrence: Clinical studies have demonstrated a significantly lower recurrence rate for patients undergoing novel corrective surgery compared to traditional methods (HR = 0.363, 95% CI: 0.150–0.880, p = 0.025).
Improved Aesthetics: The techniques prioritize preserving the natural appearance of the nipple and maintaining lactation and sensory functions.
Case Study Highlights
In a retrospective analysis conducted at the Third Medical Center of PLA General Hospital, 282 PCM patients were assessed. Among patients with nipple depression, those treated with the novel corrective surgery had a recurrence rate nearly four times lower than those undergoing conventional procedures (HR = 0.088, 95% CI: 0.009–0.886, p = 0.037). These results underscore the technique's superiority in providing durable outcomes.
The Path Forward
The novel corrective surgery represents a significant leap forward in the management of nipple depression in PCM patients. By addressing both aesthetic and functional concerns, this technique not only reduces recurrence rates but also enhances patient satisfaction. As the adoption of these techniques grows, surgeons are poised to deliver improved outcomes and set new standards in breast surgery.
Conclusion
The journey toward effective correction of nipple depression has been fraught with challenges, but advancements like the novel corrective surgery are changing the narrative. Plastic surgeons can now leverage these innovative techniques to provide their patients with long-lasting, aesthetically pleasing results, redefining the expectations in PCM treatment.
For surgeons looking to enhance their skills in advanced breast surgery techniques, exploring these novel methods can be a transformative step toward delivering superior care.
Reference:
Xu, Y., Da, B., Zhao, F., Gao, M., Xue, L., Zheng, H., Shi, H., Hou, L., Miao, S., Liu, X., Wang, Y., & Xu, H. (2023). Corrective surgery for nipple depression in patients with plasmacytic mastitis – A single-center experience. Frontiers in Medicine, 10. https://doi.org/10.3389/fmed.2023.1156628
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