Inversion of nipple – Superspeciality MCQs for MCH

Q) Simple nipple inversion is seen in?

a) Duct ectasia

b) Puberty

c) Peri ductal fibrosis

d) Carcinoma breast

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Ans is b

Inversion of nipple is seen in a lot of conditions, both benign and malignant.

Common causes are

Benign causes of Nipple inversion

Duct ectasia
After breast Surgery
Fat necrosis
Mondor disease
Chronic peri ductal mastitis

Malignancy

Carcinoma breast

Rapid unilateral development of inversion of nipple is a dangerous sign and warrants further diagnosis. Further circumferential retraction is also sign of carcinoma.

Simple nipple inversion occurring at puberty or retracted nipple is of unknown cause and is bilateral in 25%. Mostly No treatment is required for this and condition resolves spontaneously during pregnancy and lactation.

Suction pumps and cosmetic surgery can also help.

Inversion of nipple associated with malignancy may be with or without the presence of lump. Associated discharge from the nipple can point to the diagnosis.

Duct ectasia - slit like retraction of nipple . ALso seen in duct ectasia is green, black or blood stained discharge from nipple

Ref - Bailey 801

Grading of benign nipple inversions for management

In grade I, the nipple is easily pulled out manually and maintains its projection quite well. It has minimal fibrosis thus, manual traction and a single, buried purse-string suture are enough for the correction.

Grade II (majority) the nipples can be pulled out but cannot maintain projection and tend to go back again. These nipples are thought to have moderate fibrosis beneath the nipple.

In grade III, to which the least number of inverted-nipple cases belong, the nipple can hardly be pulled out manually. Severe fibrosis made it impossible to reach optimal release of the fibrotic band with the preservation of the ducts.

Ref https://www.ncbi.nlm.nih.gov/pubmed/10654681