Inverted Nipples - Causes and Treatment | Dr Jake Lim FRACS (Plast)

Causes and Correction of Inverted Nipples

If you’ve noticed that one or both of your nipples appear to be pulled inward or are not protruding as expected, you may have a condition known as inverted nipples. While this is a relatively common issue, affecting up to 20% of the population, it can cause concern. It’s important to understand that inverted nipples are usually not a cause for alarm, but in some cases, they may indicate an underlying medical condition that requires attention.

Sydney Specialist Plastic Surgeon Dr Jake Lim has experience performing different breast surgery procedures, including inverted nipples correction.

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What are Inverted Nipples?

Inverted nipples, also known as retracted nipples, are a condition where the nipple appears to be pulled inward or flat against the areola, rather than protruding outward. In some cases, the nipple may protrude temporarily when stimulated by cold or touch, but then retract again. This condition can affect one or both nipples and can occur in both men and women.

There are three primary degrees of nipple inversion, which are classified based on the severity and ease of correcting the inversion:

Grade 1: The nipple can be easily pulled out and maintains its projection for some time. The nipple ducts are typically not compromised, and breastfeeding is usually not affected.
Grade 2: The nipple can be pulled out but retracts quickly after release. Breastfeeding may be challenging, and the nipple ducts may be slightly constricted.
Grade 3: The nipple is severely inverted and cannot be pulled out manually. The nipple ducts are often constricted, making breastfeeding difficult or impossible.

It’s essential to note that inverted nipples are not inherently dangerous or harmful. However, they can cause difficulties with breastfeeding. If you are experiencing any discomfort, it’s important to consult with a plastic surgeon to determine the best course of action for your individual needs.

Causes of Inverted Nipples

Inverted nipples can develop due to many factors, ranging from congenital causes to hormonal changes and certain medical conditions. Being aware of the potential causes can help you better assess your situation and determine when to seek medical advice.

Congenital factors: Some people are born with inverted nipples due to a shortening of the milk ducts or a tight connective tissue band that pulls the nipple inward. This is the most common cause of inverted nipples and is not typically a cause for concern.
Developmental factors during puberty: As the breasts develop during puberty, the connective tissue surrounding the nipple may tighten, causing the nipple to retract. This can be more noticeable in one breast than the other, leading to asymmetry.
Pregnancy and breastfeeding: Hormonal changes during pregnancy can cause the nipples to become more prominent or protrude more than usual. However, after breastfeeding, the nipples may retract due to the stretching of the milk ducts and changes in breast tissue.
Ageing and changes in breast tissue: As we age, our skin and tissues lose elasticity, which can contribute to nipple inversion. The ligaments supporting the nipple may weaken, causing the nipple to pull inward.
Medical conditions: In rare cases, inverted nipples can be a sign of an underlying medical condition, such as:

Breast cancer: A sudden onset of nipple inversion, especially if accompanied by other symptoms like discharge, lumps, or skin changes, may indicate breast cancer and requires immediate medical attention.
Mammary duct ectasia: This benign condition occurs when the milk ducts beneath the nipple become inflamed and clogged, leading to nipple retraction and discharge.
Paget’s disease of the breast: This rare form of breast cancer affects the nipple and areola, causing symptoms like redness, itching, and nipple inversion.

It’s important to keep in mind that most cases of inverted nipples are not caused by serious medical conditions. However, if you notice any sudden changes in your nipples’ appearance, experience discharge, or have other concerning symptoms, it’s essential to consult with a doctor promptly.

When to Seek Medical Advice

While inverted nipples are often a benign condition, there are certain situations where seeking medical advice is essential to rule out any underlying health concerns and discuss potential treatment options. If you experience any of the following signs or symptoms, it’s important to consult with a healthcare professional:

Sudden onset of nipple inversion: If your nipples have always protruded and suddenly become inverted, it’s essential to have them evaluated by a doctor. Sudden inversion can be a sign of an underlying medical condition, such as breast cancer, and requires prompt attention.
Discharge from the nipple: Any unusual discharge from the nipple, especially if it is bloody, clear, or sticky, should be assessed by a medical professional. Nipple discharge can be a symptom of various conditions, ranging from benign causes like mammary duct ectasia to more serious issues like breast cancer.
Skin changes around the nipple: If you notice any redness, scaling, itching, or other skin changes affecting the nipple or areola, it’s important to have them evaluated. These symptoms can be indicative of conditions like Paget’s disease of the breast, which requires medical intervention.
Lumps or thickening in the breast: If you feel any lumps, thickening, or changes in the texture of your breast tissue, it’s crucial to have them checked by a healthcare professional. While not all lumps are cancerous, it’s essential to rule out any potential concerns.
Pain or discomfort in the nipple or breast: If you experience persistent pain, tenderness, or discomfort in your nipple or breast that is not related to your menstrual cycle, it’s important to seek medical advice to determine the underlying cause and appropriate treatment.
Difficulty with breastfeeding: If you are experiencing challenges with breastfeeding due to inverted nipples, consulting with a specialist can provide you with guidance and support to overcome these difficulties.

It’s important to remember that early intervention and treatment can make a significant difference in addressing any underlying medical conditions and improving your overall breast health.

Treatment Options for Inverted Nipples

If you are considering treatment for your inverted nipples, there are several options available, ranging from non-surgical techniques to surgical correction. The most appropriate treatment will depend on the severity of your nipple inversion, your individual goals, and your overall health. Here are some of the treatment options:

Non-surgical methods

Hoffman technique: This manual stretching exercise involves gently pulling the nipple outward and holding it in place for several seconds, repeated multiple times a day. This technique can be effective for mild cases of nipple inversion (Grade 1) and may improve nipple protrusion over time.
Suction devices: Special suction cups or breast shells can be worn over the nipple to help draw it out gradually. These devices apply gentle, consistent pressure to encourage the nipple to protrude. They are most effective for Grade 1 and some Grade 2 inverted nipples.

Surgical correction techniques

Correction Inverted Nipples.

The most common procedure for Grade 3 inversion is to try and stretch and lengthen the ducts and connective tissue to evert the nipple. Often the ducts may need to be divided to achieve this. Hence with this procedure, you will not be able to breast feed and has reduced or no nipple sensation. You will have to discuss this with Dr Lim carefully before proceeding.

Nipple-preserving techniques

These surgical procedures aim to preserve the nipple and its sensory function while correcting the inversion. This technique is only suitable for specific cases such as:

Nipple-sparing mastectomy: This procedure involves removing the breast tissue while preserving the nipple and areola. It is typically performed for patients with breast cancer or a high risk of developing breast cancer.
Nipple-areola complex (NAC) repositioning: This technique involves releasing the tight connective tissue bands and repositioning the nipple to a more projected position. It is suitable for Grade 2 and some Grade 3 inverted nipples.

Nipple reconstruction

For severe cases of nipple inversion (Grade 3) or when the nipple is damaged or lost, nipple reconstruction may be necessary. This procedure involves creating a new nipple using skin grafts or local flaps and can be performed in conjunction with other breast surgeries like breast augmentation or reduction.

It’s essential to discuss the risks, benefits, and recovery time for each treatment option with your plastic surgeon. Non-surgical methods generally have lower risks and shorter recovery times but may not be as effective for more severe cases of nipple inversion. Surgical techniques offer more definitive results but do involve incisions, potential scarring, and a longer recovery period.

Your plastic surgeon will provide you with detailed pre-operative and post-operative instructions to ensure the best possible outcome and minimise any potential complications. It’s important to follow these instructions carefully and attend all follow-up appointments to monitor your progress and address any concerns that may arise.

Remember, the decision to undergo treatment for inverted nipples is a personal one, and it’s important to choose a qualified, experienced plastic surgeon who can guide you through the process and help you achieve your desired results.

FAQs about Inverted Nipples – Causes and Treatment

Can inverted nipples affect my ability to breastfeed?

In some cases, inverted nipples can make breastfeeding more challenging, particularly if the inversion is severe (Grade 3). However, many women with inverted nipples are still able to breastfeed successfully with the help of techniques like the Hoffman technique, using a nipple shield, or seeking guidance from a lactation consultant.

Will my insurance cover the cost of inverted nipple correction surgery?

Insurance coverage for inverted nipple correction surgery varies depending on the specific plan and the reason for the procedure. If the surgery is deemed medically necessary, such as in cases where the inversion is causing significant difficulties with breastfeeding or is related to an underlying medical condition, insurance may cover some or all of the costs. However, if the procedure is considered cosmetic, it may not be covered. It’s best to consult with your insurance provider to understand your specific coverage.

Can inverted nipples be corrected without surgery?

In some cases, non-surgical methods like the Hoffman technique or using suction devices can help improve nipple protrusion, particularly for Grade 1 and some Grade 2 inverted nipples. However, these methods may not be as effective for more severe cases of inversion, and the results may not be permanent. If non-surgical treatments do not provide satisfactory results, surgical correction may be necessary.

Is nipple inversion more common in certain demographics?

Nipple inversion can affect individuals of any age, gender, or ethnicity. However, some studies suggest that inverted nipples may be more prevalent in certain populations. For example, a higher incidence of nipple inversion has been reported in Asian women compared to other ethnic groups. Additionally, nipple inversion may be more common in women who have undergone multiple pregnancies or have a family history of the condition.

Can inverted nipples recur after surgical correction?

While surgical correction of inverted nipples is generally effective and long-lasting, there is a small risk of recurrence. This can occur due to factors such as scar tissue formation, weight fluctuations, or hormonal changes. To minimise the risk of recurrence, it’s important to choose an experienced plastic surgeon, follow post-operative instructions carefully, and maintain a stable weight. In the event that nipple inversion does recur, revision surgery may be necessary to restore the desired nipple projection.

Inverted Nipples – Causes and Treatment