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Procedures not routinely provided by NHSScotland

  • Surgery to reverse nipple inversion.
  • New nipple inversion can be a sign of serious underlying disease and must be investigated and referred to the local breast surgery team.
  • Patients undergoing surgery for breast cancer or breast cancer risk reduction should not be considered under this pathway.

Clinical psychology

  • Referral to a specialist Clinical Psychologist may be made at the discretion of the vetting team.

BMI

  • Not applicable.

Considerations for treatment

  • New nipple inversion can be a sign of serious underlying disease and must be investigated and referred to the local breast surgery team.
  • Longstanding nipple inversion is common and a variant of normal and does not usually impair ability to breast feed.
  • Conservative measures using suction devices may be tried.
  • Psychology referral to aid understanding that the appearance is normal and to explore wider concerns may be of more benefit than surgery.
  • Surgery is not offered because it results in a numb nipple, renders subsequent breast feeding impossible and inversion often recurs over time.

Waiting Times

  • These patients are not subject to the 18 Weeks Referral to Treatment Standard.
  • Referrals for suspicion of malignancy should be made via the appropriate cancer pathway.

Benign nipple inversion - evidence summary

Treatment for these conditions is not routinely offered by NHSScotland and can only be considered when all criteria are met.