Everything You Need to Know About Inverted Nipples
Medically reviewed by Maria M. LoTempio, MD
Nipples that point inward or lie flat against the areola are called inverted or retracted nipples. Inverted nipples affect women and men and are either congenital (present at birth) or acquired.
Although inverted nipples are usually harmless, they can be related to serious health conditions in some cases. If you experience a sudden inversion of one or both nipples, you should contact your healthcare provider as soon as possible.
This article discusses the symptoms, causes, and treatment for inverted nipples.
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What Are Inverted Nipples?
Most nipples protrude outward from the breast. Inverted nipples are "tucked" inward or appear flush with the areola instead of protruding outward. Inverted nipples affect 2% to 10% of women and are usually bilateral (in both breasts). The only thing that physically differentiates inverted nipples from the more common protruding nipples is how they look.
Grades of Nipple Inversion
Inverted nipples are assigned a grade according to the degree to which they are inverted:
Grade 1: The nipple can be gently pulled out and easily remains protruded. The milk ducts under the nipple and areola are normal.
Grade 2: The nipple is more challenging to pull out than grade 1 and is inclined to retract when released. The milk ducts are mildly retracted, but surgical intervention is not usually necessary.
Grade 3: The nipple is difficult to pull out and retracts immediately when released. Breastfeeding will be very difficult or impossible.
Read Next: Different Types of Nipples: What You Need to Know
Causes of Inverted Nipples
Tight milk ducts and connective tissue under the nipples usually cause the inversion. New or sudden nipple inversion can occur with infection, breast injury, or invasive and noninvasive cancers.
Born With Inverted Nipples
Most people with inverted nipples are born with them (congenital). Tight or insufficient connective tissue around the nіpple or problems with the ductal system under the nipple are characteristics of congenital nipple inversion.
Age
With age, breasts change shape naturally, becoming more flat or retracted as you get older. Because milk ducts shorten during peri-menopause and menopause, this may cause the nipples to retract into your body.
Takeaway
Because breast cancer risk increases with age, consult your healthcare provider whenever you notice a change in your breasts.
Breastfeeding
Pregnancy and breastfeeding can be a cause of nipple inversion. Your nipples may flatten as your breasts fill with milk during and after pregnancy. The condition usually resolves once breastfeeding has ended.
Inverted Nipples and Breastfeeding
For those with inverted nipples prior to pregnancy, the condition can sometimes reverse naturally during pregnancy and breastfeeding. If not, inverted nipples can make breastfeeding difficult, although those with grade 1 or 2 inversions usually breastfeed successfully.
Nipple stimulation techniques can help to extend the nipples outward, so work with your healthcare provider or a lactation consultant to make breastfeeding easier.
Blocked Milk Ducts
Fluid buildup in the milk ducts can cause the breasts to become tight, pulling the nipples inward. Conditions like an abscess, mammary duct ectasia, and mastitis can block milk ducts.
Breast Injury or Surgery
Scarred milk ducts from breast fat necrosis, breast reduction surgery, and nipple piercings can cause inverted nipples.
Paget's Disease of the Breast
Paget's disease is a rare cancer that develops on the skin of the nipple and areola.
Paget's disease is often mistaken for eczema and causes symptoms, such as:
Red, dry, crusty, or flaky skin around the nipple
Itching and burning
Nipple discharge that appears bloody or yellow
People with Paget's disease usually also have ductal carcinoma in situ (DCIS) or invasive breast cancer inside the same breast and may be able to feel a lump.
Learn More: Are Inverted Nipples a Sign of Breast Cancer?
Breast Cancer
While a flat or inverted nipple rarely indicates breast cancer, it can sometimes be a symptom. Inversion may happen when a breast tumor invades the milk duct, or when cancer cells affect the nipple itself (Paget's disease). Nipple inversion usually develops suddenly and may coincide with other breast changes.
Learn More: Breast Cancer Symptoms
Abcess Under the Areola
A subareolar nipple abscess is a pocket of pus that develops beneath the nipple or areola. An abscess forms when bacteria enter the skin and cause inflammation and swelling. The abscess fills with pus—a thick, whitish-yellow fluid made up of dead/living bacteria, white blood cells, and tissue debris. An abscess may cause a lump, pain, and/or produce drainage.
Is It Normal to Have Inverted Nipples?
Healthy nipples present in a variety of sizes or shapes. As mentioned, inverted nipples are fairly common, and it is typically a harmless condition and not a cause for concern.
How to Treat Inverted Nipples
Treatment for inverted nipples depends on the cause of the condition. If the inversion is congenital, surgical approaches are available to improve the appearance and function of the nipples.
Hoffman's Technique
Introduced in 1953, Hoffman's exercise is performed by:
Placing the thumbs on either side of the nipple
Pressing down gently but firmly while pulling the thumbs apart
Repeat, stretching the nipple at all angles
Surgery
Several types of surgical techniques can correct inverted nipples. The most effective procedure depends on your unique situation.
Inverted nipple repair is performed under local anesthesia. A small incision is made underneath the lower end of the nipple to lift surrounding tissue. The tissue is then reshaped into a protruding nipple. Complementary procedures include areola reduction, breast augmentation, and breast reduction.
Nipple Eversion Devices
Nipple eversion devices are designed to promote nipple protrusion. They include breast shells, cups, and extractors (e.g., Niplette, Pippetop, Medela SoftShells, and Supple Cups).
When used over time, these devices may help to loosen nipple tissue and allow longer periods of nipple erection.
Piercings
Nipple piercing is intended to help inverted nipples to protrude more. The jewelry worn in the piercing functions to keep the nipple erect. Piercing is not effective for everyone with nipple inversion, and those who plan on breastfeeding should not pierce their nipples.
Complications and Risk Factors
Risk factors for developing inverted nipples are family history and aging. The following are complications of having inverted nipples:
Functional problems: Depending on the severity, difficulty breastfeeding, decreased sensation, or physical discomfort can be consequences of inverted nipples.
Aesthetic concerns: Some people consider protruding nipples more attractive than flat or inverted nipples.
Psychological impact: Having inverted nipples causes some people to feel self-conscious, especially during sexual activity.
If you have inverted nipples and are experiencing any of the above complications, reach out to your healthcare provider for guidance.
Are There Tests to Diagnose the Cause of Inverted Nipples?
Your healthcare provider can use a variety of tests to diagnose the cause of inverted nipples. The tests may include the following:
Physical exam: Helps your healthcare provider determine what other tests you need
Mammogram: An X-ray of the breasts that helps to identify a new mass
Ultrasound: Uses sound waves to determine if a mass is solid or filled with fluid
Magnetic resonance imaging (MRI): Provides a detailed view of the breasts
Biopsy: Removal and testing of a sample of tissue for breast cancer and other conditions
Wound culture: Helps determine what bacteria is responsible for any infection when there is drainage or a wound
When to See a Healthcare Provider
Any new or sudden changes to your nipples should be immediately reported to your healthcare provider, including:
New or sudden unilateral (one-sided) or bilateral (two-sided) nipple inversion
Fever
New breast lumps
Change in the color or texture of the nipples
Summary
Inverted or retracted nipples point inward instead of protruding out. The most common cause of inverted nipples is congenital, meaning you are born with them, but some people may acquire inverted nipples due to aging, infection, breast injuries, or cancer.
Although usually harmless, inverted nipples can lead to functional, psychological, and aesthetic consequences. There are surgical procedures that can improve inverted nipples. If you have any new or sudden changes in the appearance of your nipples, notify your healthcare provider immediately.
Read the original article on Verywell Health.
