Background: Areolar dermal flaps are common and effective corrective means used in surgical treatment. However, in some patients, the areolar area may be too small to provide enough dermal tissue flaps. Therefore, we designed tongue-like dermal flaps near the junctional area of the nipple and areola.
Objective: To present a method for congenital inverted nipple repair with a low rate of recurrence.
Methods: From January 2014 to December 2017, 50 congenital inverted nipples were surgically treated in 29 women. The women were between 18 to 36 years of age with an average age of 23.6 years. Based on the Han and Hong classification, we developed a new 3-grade classification system for inverted nipples according to clinical manifestations. Based on our classification system, 39 nipples were grade II and 11 nipples were grade III. In all cases, tongue-like dermal flaps near the junctional area of the nipple and areola were designed and used to reposition the nipple. Purse-string sutures and removal of the mons on the surface of the nipple were supplementary means used to reduce the complication rate.
Results: All patients were followed up for 3 to 6 months postoperatively with an average follow-up period of 3.8 months. No major complications such as infection, numbness or nipple necrosis were encountered. In 1 case, the purse-string suture wore out part of the skin over it 5 weeks post-operation. The wound healed 1 week after thread removal and dressing change. There was no recurrence in the follow-up period. The scars on the nipples were almost invisible in all cases. All patients were satisfied with the nipple appearance after the procedure.
Conclusion: Tongue-like dermal flaps near the junctional area of the nipple and areola is a safe and effective method for the correction of inverted nipples.

Keywords: classification, dermal flap, inverted nipple, plastic surgery

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