Nipple Correction (Inverted Nipple) Surgery Cost & Guide

What can nipple correction surgery achieve?

An inverted nipple correction aims to correct the nipple so that it projects out in a natural way. Nipple inversion is a very common condition that occurs in around one in ten men and women. It is often due to the milk ducts in the nipple being too short. These short milk ducts pull the nipple in, therefore not allowing it to protrude out naturally. This happens gradually and is often present since puberty since this is when the majority of breast changes occur. It can be present in one or both nipples. To rectify this, the surgeon will either stretch the short milk ducts or cut them. This releases the tension that is pulling the nipple in, therefore allowing it to protrude out again. Having a nipple correction can help boost self-esteem in patients, particularly when they are in intimate situations.

Nipple Correction Surgery usually costs between £2,500 and £4,000. The final price for any procedure will depend on various factors. During a consultation, the surgeon and patient will make certain decisions together that reflect the patient’s wants and needs and the surgeon’s recommendations to ensure the safest and most effective outcome.

Here is a list of some of the variants which may affect the final cost:

• Surgeon experience
• Anaesthetist experience
• Which hospital or clinic is chosen for the procedure
• The complexity of the individual procedure (linked to factors like, for example, what grade of inversion the patient has)
• Surgical techniques
• The time required in surgery for each patient’s case

These decisions will be agreed upon during the consultation; only after the initial consultation can a fixed final price be determined. Once that price is offered, however, there will be no hidden costs, and the price will include:

• Surgeon and anaesthetist costs
• Hospital costs
• Overnight stays (if required)
• Aftercare and follow-up appointments

Why do patients have nipple inversion surgery?

Although it is painless, nipple inversion can be a distressing condition that can affect self-esteem by making the breasts look distorted. It may also be an issue for women who are trying to breastfeed. This is because the baby may not be able to latch on to flat or inverted nipples to draw the milk out of the breasts. The ideal nipple correction candidates would therefore include those who are:

• Seeing little to no improvement using a non-surgical approach such as the Niplette device.
• Becoming distressed or self-conscious because of their nipple inversion.
• Having difficulty nursing their baby.
• Wanting an effective treatment with long-lasting results.

Nipple inversion grades

Nipple inversion can affect patients to different extents. There are different grades of nipple inversion depending on its severity. The surgeon will examine the patient during the consultation to determine which grade of nipple inversion there is. The three grades are as follows:

Grade 1 (mild)

• The mildest form of nipple inversion
• This can also be called “shy” nipple
• Nipples may be flat or slightly inverted
• The nipples evert in response to stimuli such as touch or temperature
• Nipple protrusion remains for some time before they return back to their inverted state.

Grade 2 (moderate)

• The nipples are slightly more inverted than grade 1
• They will evert with manipulation but will immediately return to their inverted state when manipulation stops.

Grade 3 (severe)

• This is the most severe form of nipple inversion
• There is a complete inversion of the nipples
• Stimuli will not evert the nipples.

The grade of nipple inversion may influence the surgical technique the surgeon chooses to use. The BAAPS/BAPRAS surgeons will always choose the technique that will work best for the patient's nipples.

How is a nipple correction procedure performed?

A nipple correction procedure is a relatively simple surgery to perform. It often lasts between 30 to 120 minutes, depending on the severity of the inversion.

A nipple correction procedure involves the following steps:

Consent form

Patients will meet their surgeon to sign a consent form before the procedure. This will be done either on the day of surgery or during the pre-operative assessment a week before.

Anaesthesia

This is a simple procedure; the surgeon will give a local anaesthetic, with or without IV (intravenous sedation). In some cases, however, it may be preferable to use a general anaesthetic. The surgeon will discuss which anaesthetic they will use during the first consultation.

Incisions

The surgeon will make a small incision at the base of the nipple to gain access to the milk ducts that are pulling the nipple inwards. The different techniques the surgeon can use depend on the severity of the nipple inversion, and include the following:

• Mild to moderate nipple inversion

In patients with mild to moderate nipple inversion, the surgeon can “stretch” the short milk ducts, therefore pulling the nipple outwards. The surgeon will lift the nipple and areola from the breast, stretching them and then suturing the nipples into their new position.

As this method only stretches the milk ducts and does not cut them, it is less likely to affect the ability to breastfeed. However, this technique does carry a higher risk of nipple inversion recurrence.

• Moderate to severe nipple inversion

If the nipple inversion is more severe, the surgeon may choose to cut, or divide, the milk ducts. When the surgeon cuts the milk ducts, it releases the tension that is pulling the nipple inwards. Because the milk ducts are cut, this technique will affect the ability to breastfeed. Patients may lose the ability to breastfeed entirely. There is, however, a much lower risk of nipple inversion recurrence.

After the surgeon stretches or cuts the milk ducts, they will use stitches to secure the nipple in its new projected position. The surgeon will discuss with the patient which incision is best to use for their nipples.

Closing of incisions

The surgeon will use stitches to close the incision. They will then apply a protective dressing to the nipple.

Return to the ward

The surgical staff will take the patient back to the ward to recover from the procedure, and they should be able to return home the same day.

What to expect during the consultation?

The nipple correction consultation will usually last between 15 minutes to an hour. During this consultation, patients will be able to talk to the surgeon about all aspects of the surgery. The surgeon will discuss the following:

• Why the patient wants to have nipple correction surgery
• What they would like to achieve from surgery
• Any past or future surgeries
• Current and past medical conditions or allergies
• Any personal or family history of breast cancer
• The current medications, vitamins or herbal supplements in use
• Alcohol, tobacco and drug use

After the surgeon has taken a medical history, they will then examine the nipples. They will then discuss which technique would be best to use. When deciding which technique to use, they will consider:

• The cause of the nipple inversion
• The grade/degree of nipple inversion

Questions to ask during the consultation

There are some important questions you should ask your surgeon during your nipple correction consultation. These include:

• Do you think that what I want to achieve from surgery is realistic?
• Can I see before and after pictures of similar operations you have done?
• Will I be able to breastfeed if I have this procedure done?
• Where will my scars be?

The surgeon will be able to answer all the questions patients may have. The consultation time is the patient's chance to be as honest as possible with the surgeon about what they would like to achieve from surgery.

How to prepare for nipple correction surgery?

It is important to prepare well for nipple correction surgery. Here are some tips to help prepare:

Driving

Patients will not be able to drive straight after the surgery. They may need to wait a few days following surgery before driving again. Therefore, it is important to arrange for a family member or friend to escort them home after the operation.

Supervision

Patients will need to arrange adult supervision for at least the first 24 hours after the surgery. This is because patients may still feel drowsy from the anaesthetic and painkillers.

Sleeping & resting

Be sure to have plenty of pillows as it may be more comfortable for the patient to sleep propped up after surgery. Patients should rest and sleep on their back in an inclined position (25-to-45 degree angle) for the first few days. Sleeping in this position will aid recovery by reducing the swelling and bruising.

Although patients need plenty of rest after the operation, they should be sure not to spend all their time in bed. Patients will need to get up and walk around frequently as this reduces the risk of developing blood clots after surgery.

Household items & chores

It may be very useful to place cupboard items such as mugs, crockery and dry food on the kitchen counter before surgery. This will prevent patients from having to reach up to get the items, which may place strain on the stitches. It may also be useful to clean the house and get other household chores such as washing and taking the bins out, out of the way.

Shopping & food

In order to prevent placing strain on the stitches, patients should avoid heavy lifting for the first few weeks after surgery. It would therefore come in handy to do a big food shop before the day of the surgery. It could also be a good idea to prepare some meals for the freezer ready so they are ready for the recovery period.

Children & pets

It may be a good idea for family and friends to help take care of young children and pets during the initial recovering period, as lifting infants or being pulled by lead could be uncomfortable.

Diet

Sticking to a healthy, balanced diet will help the recovery process. Try to eat high-protein, low-sodium foods with lots of fresh fruits and vegetables. Patients should also drink lots of water and caffeine-free drinks. Try to avoid eating food and drinks that have a high amount of salt or sugar.

Clothing

Patients should not wear clothes that compress the nipples for at least two weeks. This includes padded bras and tight-fitting tops. Try to pick loose, comfortable clothing to wear after the nipple correction. The surgeon will make clear if the patient will need to bring a compression garment on the day of the operation.

Surgical advice

To help reduce the risk of complications occurring during and after surgery, surgeons typically advise:

• Alcohol, a high BMI, recreational drug use and smoking are all factors that can increase your risk of developing complications.
• Therefore, our surgeons strongly advise that patients stop smoking and using all nicotine products at least six weeks prior to the surgery. This is because smoking increases the risk of infection and can delay wound healing.
• It is important to be aware that many homoeopathic medications available over the counter can also increase the risk of complications. This includes Aspirin, St John’s Wort, multivitamin preparations and any medications that include: ginger, ginkgo, garlic and cod liver oil.
• Patients should therefore stop taking all homoeopathic medications at least two weeks prior to the surgery. This will help reduce the risk of postoperative bleeding, excessive bruising and haematoma.

What are the main nipple correction risks and complications?

It is important to be well informed about the nipple correction risks and complications. The surgeon will discuss these during the consultation.

The nipple correction risks and complications include the following:

Inability to breastfeed

Depending on the type of surgical technique the surgeon uses, the ability to breastfeed may reduce or be lost completely. The surgeon will, however, try their best to conserve as many milk ducts as possible. Because a nipple correction can affect the ability to breastfeed, the surgeon will usually advise that patients complete their family before having the procedure.

Scarring

As surgery requires the surgeon to make surgical incisions, scarring is unavoidable. The scars should be minimal and will fade over time. The severity of the scarring does, however, also depends on the ability of the skin to heal. Some patients are at risk of developing more severe scarring such as hypertrophic or keloid scars. Most patients will already be aware if they are likely to develop these types of scars.

Seroma

A seroma is a pocket of fluid that can develop under the skin’s surface. It usually develops below the incision line and is usually mild. It will often resolve on its own, but the surgeon may have to drain the fluid out in some cases.

Numbness or loss of nipple sensation

Some patients may experience alterations in their nipple sensation. This can either increase nipple sensitivity (over-sensitivity), reduce nipple sensitivity (numbness) or cause nipple pain. Any changes in nipple sensation are usually temporary and should settle within a few months. It is possible for these changes to become permanent, although this is very rare.

Infection

Infection is a risk that comes with any surgery. In most cases, these are mild wound infections that settle down with antibiotic treatment. If, however, the infection becomes more severe, patients may need to have further surgery.

It is important to be aware of the signs of an infection. Patients should tell their surgeon if they experience any of the following:

• A temperature of 38° C or over
• Redness and/or swelling at the incision site that worsens over time
• Pus-like or foul-smelling discharge coming from the incision or the drain sites
• Increasing pain that is not relieved by pain medication

Aesthetic

It is important to be aware that patients may be unhappy with the aesthetic results of nipple correction surgery. For example, they may not be happy with the size, shape or symmetry of your nipples. To reduce the risk of disappointment, patients should make sure the surgeon understands their expectations.

Nipple re-inversion

After a nipple correction, there is a chance that the nipples may invert again. If this does occur, it is likely to happen in the first few days to weeks after the surgery. The chance of this happening also depends on the technique the surgeon chooses to use. A technique that stretches the milk ducts as opposed to cutting them carries a higher risk of nipple re-inversion.

If the nipples do re-invert, the surgeon will discuss further options with you. This may include needing to have further corrective surgery.

Necrosis

During the surgery, the blood supply to the nipples, skin or tissues may be lost. If this does occur, the affected area (such as the nipple) may die. This is called ‘necrosis’. It is a rare complication. If it does develop, patients may need to have further surgery to remove the dead tissue (surgical debridement).

Bleeding & bruising

It is very common to experience some bleeding and bruise after the procedure. This usually occurs straight after surgery and should settle down over time. The bleeding and bruising are often mild, but in some cases, they can be more severe. Large amounts of bleeding may result in developing a blood clot under the skin (haematoma).

If patients notice a large amount of bleeding or bruising or increase over time, they must notify their surgeon. Patients may need to have further surgery to correct this.

It is important to choose an experienced BAAPS/BAPRAS surgeon. This reduces the risk of these complications occurring.

What to expect after a nipple correction?

The surgeon will give specific advice regarding the nipple correction aftercare. They will cover the following points:

Post-operative appointment

Patients will usually be able to return home on the day of nipple correction surgery. The surgeon will schedule a post-operative appointment after the procedure. This will usually take place within one to two weeks after the surgery. During this appointment, the surgeon will remove any dissolvable stitches, examine the nipples, and address any surgical complications.

After having nipple correction, the surgeon will give specific advice regarding the time-frames for:

• Time off work
• Return to sports & exercise
• Showering & bathing
• Return to driving

Each surgeon has different advice for nipple correction aftercare. It is therefore very important to follow the instructions that the surgeon has given, as these are specific to the individual patient's recovery.

Time off work

The amount of time patients will need to take off work after having nipple correction will depend on the type of job they have. If the work involves a lot of physical activity, patients will have to take at least one week off. If it does not involve a lot of physical activity, then patients may only need three to five days off work.

Return to sports & exercise

Although patients need to rest well when they return home, it is important that they do not stay in bed all day. Patients should take occasional, light walks after surgery. This helps the blood flow in the legs and reduces the risk of developing a blood clot in the leg (which is called a deep vein thrombosis). Despite this, patients should consider the following advice regarding sports and exercise:

Recovery timeline

Week 1 – 2

Patients should avoid all sports and exercise for the first two weeks after having nipple correction surgery. This is because even minor aerobic activity may increase swelling, therefore prolonging the recovery time.

Week 2 – 3

Light exercises that do not involve vigorous movement, such as cycling, may be resumed.

After Week 3

Patients should be able to resume all sports and exercise three weeks after having nipple correction surgery.

Driving

As patients will not be able to drive straight after surgery, they must arrange for a friend or family member to take them home. Patients should be supervised for the first 24 hours after surgery. This is because patients may still have some side effects from the anaesthesia and painkillers.

Scar care

There are a number of techniques that surgeons may recommend that can aid the healing of the scars following surgery:

1. Scar massage – gentle massage of the scar area may benefit healing. This should only be done once the incision has fully healed and the scab has completely disappeared on its own.
2. Silicone sheets/gels/creams – using silicone-based products on the scars for six months to one year can help reduce the appearance of scars. Patients may use these products only after the glue or tape from surgery has been taken off and the incisions have fully healed.
3. Avoid exposing the scars to sunlight or sunbeds. Use sunscreen to protect the healing skin and avoid colour differences.

The surgeon will give specific advice regarding the healing and care of your scars.

Final results

Although patients will see a difference in the nipples immediately, it may take up to six weeks to appreciate the full cosmetic results. Patients should also avoid compressing the nipples in the first few weeks after surgery. This means avoiding movements such as lying on the stomach or hugging in the first few weeks. The nipple correction aftercare advice can be different for each patient.

If you have recently given birth, you may need to wait 3 to 6 months before you have your nipple correction procedure.

Your surgeon may require you to stop breastfeeding for 3 to 6 months before your nipple correction. This is to allow the breasts and nipples to have enough time to settle before your procedure. If you have recently given birth or are planning on having children in the foreseeable future, you should notify your surgeon in your initial consultation. They will advise you on the best course of action.

There is a chance that after a nipple correction, your nipple may invert again. This mainly depends on the technique that your surgeon chooses to use. It is more likely to occur when the short milk ducts are pulled and not cut or divided. If this occurs, you may require further surgery to correct this.

While you may notice an immediate difference in the appearance of your nipples, your final results will take time. It can take up to 6 weeks to appreciate the full cosmetic results. By this time, any swelling and bruising will have settled, and scarring should start to fade.

The use of cigarettes, alcohol and recreational drugs can increase the risk of complications occurring both during and after surgery. BAAPS/BAPRAS surgeons strongly recommend that patients stop smoking and using any nicotine products for at least 6 weeks before their surgery.

All of the information found on our website is sourced from highly reputable experts, government-approved authorities and is widely used by healthcare professionals.

• https://academic.oup.com/asj Aesthetic Journal of Plastic Surgery