title: Treatment of the benign inverted nipple: A systematic review and recommendations for future therapy.
abstract: The inverted nipple is a frequently encountered problem which can cause difficulties with breastfeeding, sexuality, and aesthetic dissatisfaction. Up to now, no consensus exists on a preferred treatment method. We performed a systematic review to identify the best treatment method for correction of benign inverted nipples. Treatment techniques were subdivided in the categories lactiferous duct preserving and lactiferous duct damaging. A systematic review was performed using the PRISMA statement. Inclusion criteria were: female patients with congenital or acquired inverted nipples, a minimum sample size of 10 nipples, and studies reporting recurrence of inversion with a minimum follow-up of six months. Exclusion criteria were nipple inversion caused by malignancy. Thirteen studies met the inclusion criteria which all had a level of evidence IV. No non-invasive treatment techniques were identified. In the duct preserving category eight studies were included with a recurrence rate of 0.6% (2/350) versus 9.9% (16/161) in the duct damaging category (n = 5). Other outcome parameters were not systematically reported in all studies. Because of a small number of low quality studies with heterogeneous interventions and outcomes a meta-analysis could not be performed and no preferred treatment method was identified. Based on the available data there is no statistical evidence that duct damaging treatment is superior to duct preserving treatment. We recommend that the first method of choice should be a duct preserving treatment method. In the future, more studies of better methodological quality are required and recommendations were made on how these could be conducted.
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Q M
authors.initials: QM
authors.lastname: Hernandez Yenty
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: W J F M
authors.initials: WJ
authors.lastname: Jurgens
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands; MOVE Research Institute, VU, Amsterdam, The Netherlands.
authors.forename: P P M
authors.initials: PP
authors.lastname: van Zuijlen
authors.affiliation: Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: H C W
authors.initials: HC
authors.lastname: de Vet
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, The Netherlands. Electronic address: paulineverhaegen@hotmail.com.
authors.forename: P D H M
authors.initials: PD
authors.lastname: Verhaegen
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005544:Forecasting; D006801:Humans; D008875:Middle Aged; D009558:Nipples / Q000002:abnormalities* / Q000293:injuries / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods / Q000639:trends*; D055815:Young Adult
keywords: Depressed nipple; Inverted nipple; Retracted nipple; Systematic review