Nipple inversion is usually caused by contraction and scarring of the breast ducts draining into the nipple. Most of the time this is due to non-cancerous conditions. However, it is important to see a general surgeon who deals with breast cancer as one needs to exclude breast cancer as a cause.
Procedure:
This can be done under general anaesthesia or local anaesthesia alone.
The breast is prepped and draped.
A suture is placed to pull up the retracted nipple
A tiny keyhole incision is made in a corner of the base of the nipple – the ducts are cut
The wound is sutured – with the suture also going through the base of the nipple to prevent further inversion in future
The nipple is then dressed around a sponge dressing
Risks:
Not being able to breast feed anymore on that side
Loss of sensation on the nipple
Nipple ischaemia – loss of blood supply to the nipple
Pain
Scar
This is written with the aim of helping my medical students and doctors in training go through my thought process in the outpatient clinic. This list is not meant to be all comprehensive but rather a practical guide in coming to a diagnosis quickly.
Take a full history:
including age, past history and family history
age of menarche, menopause and pregnancies(breast feeding history)
Ask too for nipple discharge ?blood stained(papilloma and cancer), greenish(duct ectasia, fibrocystic disease)
On examination:
Feel for suspicious features of a breast cancer – be especially suspicious of any hard lump in woman over 50yo
In young woman, if the lump is mobile – most likely fibroadenoma
Investigation:
Ultrasound ?fibroadenoma ?cyst ?breast cancer
Mammogram
Tissue diagnosis to complete triple assessment – Fine needle aspiration cytology , biopsy
Other causes –
Skin/subcutaneous lump – epidermal cyst
Silicone granuloma – there are some patients who may have had injections of silicone overseas many years ago(now the women are usually more than 50 years old and their breast cancer risks are increasing)