陥没乳頭の手術療法—酒井法—

Surgical Correction of Inverted Nipples: The Sakai Method

はじめに

　乳頭が乳輪下へ陥没している状態を陥没乳頭という。この状態には外見から受ける精神的な苦痛はもとより，妊娠・出産しても授乳ができない機能的な問題がある。また，陥没乳頭を放置していると，乳輪下膿瘍や乳腺炎になりやすい。酒井法は陥没した乳頭を縦割りに切開し，乳管と平行に侵入し剥離して，授乳の必要な症例においては乳管を温存しつつ，短縮性の組織を十分に剥離し伸展する方法で，授乳ができる可能性を増した有用な方法である。手術は外来，局所麻酔，日帰りで十分行える 1）～9）。

　Some severe cases of inverted nipples cannot be corrected by simple methods, especially if the nipple never comes up from the areola. For these cases we use a vertical cutting method.

　To avoid the recurrence of nipple retraction and to maintain the lactiferous function, we perform a surgical procedure in which an incision made on the nipple is deepened vertically to free the lactiferous ducts from the contracted tissues surrounding them. After extension or resection of the restricting tissues, the nipple is raised. The protrusion of the nipple is then achieved by gathering it with inside sutures, which are fastened without damaging any of the lactiferous ducts.

　In cases that are not amenable to treatment by this technique （method 1）, the following method should be used. In method 2, the nipple is raised as described above and fixed with dermal flaps that form a structure like a suspension bridge at the base of the nipple, and a z-plasty or dog-ear resection is performed as in method 1.

　For intractable cases with a scarred nipple due to a prior procedure, we use method 3, in which we gather and bring up surrounding areola tissue and secure it with inside sutures after the scar’s resection, and then we apply outside sutures only at the base of the neck of the nipple, leaving a raw surface on the top and sides of the new nipple. We remove dog ears of the areola at both sides of the nipple neck.