Treatment of Inverted Nipple with Subareolar Abscess: Usefulness of High-Resolution MRI for Preoperative Evaluation
A 27-year-old woman. Inverted nipple with subareolar abscess. The abscess was extended subcutaneously beyond the areola and was stained blue by indigo carmine injection (arrow) (a). Sonography: the abscess was depicted as hypoechoic areas (arrows) (b). High-resolution MRI (Contrast-enhanced T1-weighted image): abscess cavity (thick arrow) is hypointense structure with thin marginal enhancement. Small fistula (thin arrow) is hypointense linear structure associated with well-enhanced inflammatory stroma (c). Surgical design. Dermal flaps were created at the neck of the nipple on both sides of the incision (thin arrows: before deepithelialization). The dermal flaps on both sides were marked for Z-plasty. The abscess extended beyond areola (thick arrow). Thus, an arc-like additional incision was made along the areolar margin and the affected area was reliably resected (d). After completion of surgery, frontal aspect. A portion of the nipple was not sutured and was left as a raw surface to create roundness of the nipple (e). After completion of surgery, lateral aspect (f). Seven months after surgery, frontal aspect. There was no recurrence of subareolar abscess (g). Seven months after surgery, lateral aspect. Since the neck of the rounded nipple was constricted, the nipple was less prone to reinvert (h).
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