Treatment of small breasts and inverted nipples

Augmentation mammoplasty is one of the most popular aesthetic surgical procedures in the world and the number of cases performed continues to increase yearly. This chapter presents a comprehensive review of this topic which includes implant selection, surgical approaches, management of complications, and some of the pitfalls associated with this popular procedure. The chapter also covers the classification and treatment of inverted nipples.

Breastfeeding success with the use of the inverted syringe technique for management of inverted nipples in lactating women: a study protocol for a randomized controlled trial

Background Breastfeeding provides ideal infant nutrition, conferring several health benefits to children and their mothers. Women with inverted nipples, however, face difficulties that force them to prematurely terminate breastfeeding. Whereas available conservative measures for the correction of inverted nipples are of limited success, the use of an inverted syringe may be effective in achieving high rates of infant latching and exclusive breastfeeding. This technique, however, has not been investigated in a clinical trial. Methods/design This open-label randomized controlled trial aims to investigate whether, in women with inverted nipples, the use of an inverted syringe increases the rate of exclusive breastfeeding at one month compared to standard care. One-hundred healthy women with grade 1 or 2 inverted nipples will be recruited as of 37 weeks of gestation. They will be randomly allocated to standard care (control group) or to an intervention group. The intervention consists of using an inverted syringe to evert the nipple before every breastfeed, starting with the first feed after delivery. The primary outcome measure is the rate of exclusive breastfeeding at 1 month. Secondary outcome measures include exclusive breastfeeding rates at 3 and 6 months, nipple eversion rate, successful latching rate, rates of any breastfeeding at 1, 3, and 6 months, breastfeeding-associated complications, maternal satisfaction with breastfeeding, maternal quality of life, and adverse events. Descriptive and regression analysis will be conducted under the intention to treat basis. Discussion The use of the inverted syringe to evert inverted nipples is a simple, inexpensive, and safe technique that can be performed by mothers with inverted nipples. Findings of this trial, if positive, will provide much needed evidence for a safe, affordable, readily available, and simple intervention to treat inverted nipples, and improve breastfeeding practice among affected women. Trial registration ClinicalTrials.gov, NCT03529630. Registered May 8, 2018.

Central Tunnel Technique and Fat Grafting for Surgical Correction of Inverted Nipples and Introduction of a Treatment Algorithm

Background Inverted nipples are prevalent in 3% to 10% of women and can often cause functional, psychological, and aesthetic problems. Objectives The authors sought to treat inverted nipples and restore the aesthetic appearance of the nipple while minimizing ductal disruption, preserving the ability to breast-feed, and reducing recurrence rates. Methods A retrospective review was performed on a total of 161 inverted nipples in 86 consecutive patients who underwent correction of inverted nipples at Oslo Plastic Surgery Clinic. Mean age at operation was 28.7 years and mean follow-up period was 14 months. A novel technique with central tunnelization of the retracted fibers/ducts was employed in 39 patients (45%); partial incision of the center of the inversion through a tunnel in 31 patients (36%); and total cut of the lactiferous ducts in 16 patients (19%). Fat grafting was utilized as support in 14 patients (26 nipples). Postoperatively, nipples were suspended for 4 weeks with a manually constructed device. Results Most patients had moderate (grade 2, 40 patients) or severe (grade 3, 52 patients) nipple inversion. Infection occurred in 4 patients and 2 patients had local irritation. Recurrence was seen in 32 patients (55 nipples) after the first operation, in 6 patients (6 nipples) after the second operation, and in 1 patient (1 nipple) after the third operation. Conclusions The authors propose a treatment algorithm that addresses important therapeutic goals when treating inverted nipples. Clinical examination is crucial to determine the method to be employed. The new central tunnel method and fat grafting to support the nipple are promising, although additional follow-up is necessary. Level of Evidence: 4

Unusual Presentation of PMM2-Congenital Disorder of Glycosylation With Isolated Strokelike Episodes in a Young Girl

Congenital disorders of glycosylation (CDG) are multisystemic inherited metabolic disorders with marked phenotypic variability. The most frequent described type is PMM2-CDG (earlier known as CDG Type Ia) which presents either with pure neurologic features or with combined neurologic and systemic features. The classical presentation is characterized by varied combinations of developmental delay, hypotonia, ataxia, dysmorphism, inverted nipples, and abnormal fat distribution. Strokelike episodes and seizures are known acute complications that usually occur on a background of developmental delay, ataxia, or dysmorphism. We report here a developmentally normal young girl who presented with isolated strokelike episodes and was diagnosed to have CDG Type Ia. This condition should be kept in the differentials of unexplained strokelike episodes in children. The diagnosis has important therapeutic and prognostic implications.

From gestalt to gene: early predictive dysmorphic features of PMM2-CDG

IntroductionPhosphomannomutase-2 deficiency (PMM2-CDG) is associated with a recognisable facial pattern. There are no early severity predictors for this disorder and no phenotype–genotype correlation. We performed a detailed dysmorphology evaluation to describe facial gestalt and its changes over time, to train digital recognition facial analysis tools and to identify early severity predictors.MethodsPaediatric PMM2-CDG patients were evaluated and compared with controls. A computer-assisted recognition tool was trained. Through the evaluation of dysmorphic features (DFs), a simple categorisation was created and correlated with clinical and neurological scores, and neuroimaging.ResultsDysmorphology analysis of 31 patients (4–19 years of age) identified eight major DFs (strabismus, upslanted eyes, long fingers, lipodystrophy, wide mouth, inverted nipples, long philtrum and joint laxity) with predictive value using receiver operating characteristic (ROC) curveanalysis (p<0.001). Dysmorphology categorisation using lipodystrophy and inverted nipples was employed to divide patients into three groups that are correlated with global clinical and neurological scores, and neuroimaging (p=0.005, 0.003 and 0.002, respectively). After Face2Gene training, PMM2-CDG patients were correctly identified at different ages.ConclusionsPMM2-CDG patients’ DFs are consistent and inform about clinical severity when no clear phenotype–genotype correlation is known. We propose a classification of DFs into major and minor with diagnostic risk implications. At present, Face2Gene is useful to suggest PMM2-CDG. Regarding the prognostic value of DFs, we elaborated a simple severity dysmorphology categorisation with predictive value, and we identified five major DFs associated with clinical severity. Both dysmorphology and digital analysis may help physicians to diagnose PMM2-CDG sooner.