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Multilevel Z-plasty for Inverted Nipple Correction
Some women suffer from inverted nipple issue and find it quite embarrassing.
Nipple Inversion can affect one breast or both, but most cases are bilateral. The causes of inverted nipple can be divided into two:
1.Congenital underdevelopment: Lack of partial muscle and fibrous tissues or presence of focal fibrosis, resulting in less soft tissue under the nipple base to support the nipple being protruding.
2.Acquired inverted nipple: If this is a new symptom that never had before, it may be a sign of cancer. No matter if it is accompanied with blood or other type of nipple discharge or lump around the areola area, an appointment with the GYN clinic as soon as possible for further evaluation is highly recommended.
Inverted nipple can cause functional problems for breastfeeding, negatively affect body image due to lack of sexy nipple pokies, and interfere with sexual enjoyment. It is undeniable that nipples are the most sensitive part of women, thus retracted nipples would be a pity.
An inverted nipple looks like a slip on the nipple, which may negatively affect appearance and nipple hygiene. It is not easy to clean the inverted nipple area and the patients may suffer from irritating sensation and even rashes or infections. Inverted nipples also make breastfeeding more difficult. During nursing, the nipples have to be pulled out for baby to latch, which are prone to get sore, cracked, bleeding and even develop mastitis.


Most women with nipple issues are hesitant to seek surgical treatment because they wrongly believe that surgery on sensitive nipple area cause severe pain. In fact the nipple surgery can be performed under local anesthesia. The patient undergoing surgery will only feel pain during the 30-40 seconds while being given injection of local anesthetics at the areola area. Otherwise, intravenous general anesthesia is an alternative option to help ease the patient's fear.

In Charm United Institute, we perform multilevel z-plasty to correct any grades of nipple inversion.

A Z-shaped incision is made and the inverted nipple is retracted out and split. The underdeveloped lactiferous ducts and the surrounding contracted fibrous tissues are released. Then the Z-shape flap is transposed to restore sufficient nipple protrusion and fill the dead space with underlying breast and connective tissues.

Compared to other surgical approaches, such as nipple retractor support with wires or flap-plasty, multilevel z-plasty can be used to correct any grades of inverted nipples with a simple incision and Z-shaped flap. Due to its advantage of simple incision, nearly invisible scar, good surgical outcome and low recurrence rate, multilevel z-plasty has become the standard surgical procedure in our clinic to correct nipple inversion.


Multilevel Z-plasty for nipple inversion correction





The surgery is performed under local anesthesia. The patient will only feel pain during the 30-40 seconds while being given injection of local anesthetics at the areola area.

Conventional liposuction using cannula in larger diameter to harvest fat for autologous fat transfer breast augmentation may have a shorter duration of liposuction procedure. However it cannot precisely collect usable fat grafts in good quality. Besides there is higher chance that the harvested fat grafts get exposed to the air during the subsequent centrifugation and reinjection procedures. In Charm United Institute, our team of skilled surgeons use calibrated equipment and liposuction cannula in smaller diameter that greatly improves the surgical outcome and reduce risk of postoperative complications.


Q 1. What are the causes of inverted nipples?

Causes of inverted nipples can be congenital underdevelopment or acquired medical conditions. Congenital nipple inversion occurs during fetal development or adolescence, which are caused by underdevelopment or fibrosis of lactiferous ducts. Medical condition can also cause nipple retraction, such as the tumor attacking the ducts behind the nipple and pulling it in.


Q 2. Is surgery the only treatment for nipple inversion?

Women with inverted nipple may seek treatment for aesthetic reasons or breastfeeding issues. If you're looking for something permanent, the only option is surgery.


Q 3. Does inverted nipple relapse after surgical correction?

In Charm United Institute, we perform multilevel z-plasty to correct any grades of nipple inversion. As long as the surgery is well performed to separate the contracted fibrous tissue, pull out the nipple, followed by securing the protruding nipple firmly to a proper position, the recurrence rate is fairly low.


Q 4. Can women underwent nipple inversion correction surgery breastfeed?

It depends. Usually patients with preoperative inverted nipple in lower grade preserve better breastfeeding function after surgery.


Q 5.Can nipple inversion correction surgery affect sensation?

The surgery procedure performed in our clinic rarely affects nipple sensation. About 90% of the patients have almost unchanged sensation.


Q 6. Can I sleep on stomach after nipple inversion correction surgery?

It is recommended that patient underwent nipple surgery should avoid sleep on stomach for one month at least to prevent the nipple being pressed leading to recurrence of inversion.



  1. Do not ride a motorcycle or drive home after surgery (for patients who received eye or sleep anesthesia).
  2. Avoid strenuous exercise and do not lift heavy objects within two days after operation to avoid blood vessel rupture and swelling.    
  3. Do not remove the bandages or fixing device yourself.    
  4. Apply ice compression on the first 2 days (48 hours) after the surgery, and from the third day on, apply warm compression until the swelling is gone (please pay attention to the temperature of warm compression to avoid burns).    
  5. Take medication on time for 4 times a day (after meals and before sleep). If the pain is severe, take painkillers once every 3 hours.    
  6. Wound care: Use saline solution and cotton swabs to clean the wounds, wipe dry, and then apply the ointment every morning and evening.    
  7. Don't let the wound contact with water within 2 days after the surgery. From the third day on, use clean water to clean the wound. Do not use cleaner within 7 days after surgery to avoid irritation.
  8. Do not smoke, drink alcohol, tea or coffee, or have pepper and other irritating food within a week after the surgery to avoid affecting the postoperative wound from healing.    
  9. No seafood during the first week after the surgery to avoid allergies (except for fresh fishes).


Dr. Yi-Sheng Kao Director | Plastic Surgery Aesthetic Clinic

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