If the Nipples Are Too Far Inward? Lateral Flap vs. Superior Flap

Hello.

When consulting about reduction surgery,

you come across a variety of breast shapes.

It is easy to think,

'A large, sagging breast is basically all the same,'

but

in reality, it is a little more complex.

The size of the breasts and the degree of sagging

vary from person to person,

and especially because each breast has a different

nipple position.

In the case of people undergoing breast reduction, there is generally

a common feature of large, sagging breasts,

but even among sagging breasts,

the surgical plan and design will differ depending on

whether the nipple is偏向ed to the upper, lower, left, or right side.

And depending on the nipple position,

the flap to be used is determined,

and depending on the choice of flap,

the surgical method is changed.

What is a flap?

Basically, a flap is

a long strip of tissue that must be left behind

to preserve the blood vessels leading to the nipple.

The flaps mainly used at present are

a superior flap or a medial flap,

or a combined form of the two,

a superomedial flap.

In breasts with severe sagging,

a medial flap is mainly used.

One of the difficult cases when selecting such a flap is

when the nipple is very saggy and is located not in the center of the lowest part of the breast,

but excessively inward.

And cases like this are

more common than you might think.

The reason is that glandular tissue is distributed more toward the outer side of the breast than the inner side, so

in the case of a large breast with developed glandular tissue,

the outer side often becomes larger than the inner side.

When the outer side becomes large and heavy,

the outer skin inevitably stretches more than the inner skin.

Accordingly, the sagging nipple

does not remain in the central part of the sagging breast,

but is drawn inward toward the cleavage area.

In this overly sagging state,

if the nipple is located inward,

and a medial flap is used without thinking,

the flap becomes excessively short,

and when the flap is moved, the blood vessels can kink,

making circulatory problems more likely.

In other words, the risk of nipple necrosis increases.

So when the nipple is positioned inward

in a sagging breast,

the flap design can be modified to some extent to compensate,

but if it is positioned very偏向ed, there are roughly two approaches to consider.

The first is to use a lateral flap.

By making the flap at some distance from the inwardly drawn nipple,

you can avoid nipple necrosis.

However, there is also a downside to this.

Using a lateral flap means leaving the outer glandular tissue behind,

so the outer tissue cannot be removed sufficiently,

making it impossible to reduce the breast enough overall,

and it may leave a stretched appearance on the outer side.

The second is to use a superior flap.

Its advantage is that the outer side, where most of the glandular tissue is located,

can be sufficiently excised,

and it can produce excellent results with a balanced ratio between the medial and lateral sides.

The downside is that in a breast with significant sagging,

using a superior flap means the flap must be longer,

and when the flap becomes longer, there is more residual tissue,

making it harder to reduce the breast size.

Also, the longer the flap,

the lower the stability of blood flow.

In conclusion,

if the nipple is偏向ed inward,

two choices can be made.

From the standpoint of safety - lateral flap

Shape - superior flap

This is how it can be summarized.

Today, I explained how surgery is performed

when the nipple is excessively drawn inward

in a sagging breast.

The reason I explained this specific case is that

many people tend to be fixated on one method,

that is, being tied to scars and obsessing over anchor, vertical, or J-shaped patterns when having surgery.

However, not every sagging breast

can be operated on in the same way.

Depending on the size, degree of sagging, skin elasticity, and nipple position,

each person’s situation is different,

and choosing the appropriate method for each situation

is what can lead to good results.

Thank you.