The areolas constitute the morphological-aesthetic reference, and breast tenderness, also allow the breastfeeding function to be culminated.
1. REMOVAL OR INVESTMENT OF NUTS
They usually affect one side, although there are bilateral ones. They can have congenital origin: permanently depressed or invaded, with an incidence between 3 and 10% of women, to which we must add acquired causes (due to breast hypertrophy, ductal mastitis, breast carcinoma, previous breast surgery, or pregnancy). Therefore, it is very important to make an accurate diagnosis of the underlying alteration by thorough examination sometimes complemented with imaging studies, to rule out underlying existence of Paget’s disease of the nipple that may be associated with breast carcinoma.
In the last 125 years, in congenital forms, multiple surgical techniques have been described to attempt correction. In mild to moderate cases, there is a weakness or lack of supportive tissue, with shortening of galactophores ducts, while in the most severe or grade III, in addition to alterations in the contraction of smooth muscle fibers.
The originally developed techniques have involved interrupting galactophores ducts or damaging nipple sensitivity, even filling back retrogradely with own tissue planes (glandular, dermal flaps, even own cartilage), all causing scars and sensory losses as well as functional. Most of the techniques in recent decades come from Asia, and are very ingenious. But since 2005, there are simpler techniques that allow the nipple to be exteriorized, with a very low incidence of recurrence or reappearance of the investment, without visible scars, completely preserving sensitivity and function for future lactations. These are outpatient procedures, without hospital admission, of short duration, performed under local anesthesia, which are continued intermittently through consultation visits.
2. PEZONES HYPERTROPHY
It is a much less frequent condition, related to family history, and which manifests itself especially after maternity. It is usually bilateral, and they become more evident when areola and nipple contract. It can be associated with other breast abnormalities. Its ideal correction, under local ambulatory anesthesia, was described in 1975 and allows preserving both sensitivity and ability to breastfeed, as well as an immediate return to daily activities.
3. OTHER SITUATIONS AS:
POLITELIA (supernumerary nipples), ATELIA (absence of nipples), FISURED, among others. All these presentations, according to a particular case study, may have a reconstructive opportunity