Treatment of Inverted Nipple with Subareolar Abscess: Usefulness of High-Resolution MRI for Preoperative Evaluation

Background. Inverted nipples with subareolar abscesses can recur due to insufficient resection. It is important to provide reliable curative treatment after determination of the extent of resection by preoperative imaging evaluation. Methods. Ten patients were treated for inverted nipples with subareolar abscess. Sonography and high-resolution MRI were used as preoperative imaging modalities. The endpoints of preoperative imaging evaluation were defined as the identification of the abscess site, isolated fistula site, and extent of inflammation. Results. In all patients, sonography confirmed the presence of abscesses but their locations could not be identified. Sonography could not confirm the presence of isolated fistula or inflammation. In contrast, high-resolution MRI not only confirmed the presence of abscesses but also revealed their positional relationships with the nipples. In addition, high-resolution MRI confirmed the presence of isolated fistulas and inflammation as well as revealed their positional relationships with the nipples. In all patients, no recurrence was observed, and satisfactory surgical results were obtained. Conclusion. High-resolution MRI is useful in determination of the extent of resection of subareolar abscess associated with inverted nipple. 1. Introduction Inverted nipples are esthetically unacceptable for many young women. In addition, they can make breast feeding difficult and cause mastitis and repeated subareolar abscesses. Recurrent subareolar abscesses can lead to esthetic problems such as multiple scars and nipple and breast distortion. In addition, they can cause symptoms such as areolar pain and fistula, resulting in major interference in daily living [1]. In recurrent cases, surgery is more difficult compared with cases undergoing initial surgery. Therefore, it is important to provide reliable curative treatment by initial surgery. However, there are many recurrent cases due to incomplete treatment [2, 3]. Surgery should be performed after determination of the extent of resection by preoperative imaging evaluation. This method is considered useful to improve the treatment outcomes by enabling reliable and optimal resection of the affected area. In this paper, we report on preoperative high-resolution MRI which was useful in image-guided surgery for the treatment of inverted nipple with subareolar abscess. 2. Materials and Methods Ten patients were treated for inverted nipples with subareolar abscesses. All patients were women and their mean age was 31 years (range: 22 to 51 years). Their follow-up periods were at