Understanding Inverted Nipples: Causes, Signs, and Effective Treatments

What Are Inverted Nipples?

Inverted nipples, sometimes referred to as retracted nipples, occur when the nipple points inward or lies flat against the breast instead of protruding outward. This condition can affect one or both breasts. Some individuals are born with inverted nipples, which is often harmless. However, if the inversion develops later in life, it may indicate an underlying medical issue that warrants evaluation by a healthcare professional.

Understanding the Grades of Nipple Inversion

Nipple inversion is categorised into different grades, depending on the severity of the condition. These grades help determine the appropriate treatment and management options.

• Grade 1: The nipple can be easily pulled outward and may occasionally protrude on its own due to cold temperatures or stimulation. Breastfeeding is typically unaffected at this stage.

• Grade 2: The nipple can be manually pulled outward, but it tends to retract back to its inverted position shortly after. Breastfeeding may be more challenging in this grade.

• Grade 3: This is the most severe form of nipple inversion. The nipple cannot be pulled outward manually, and breastfeeding is often not possible.

What Causes Inverted Nipples?

Inverted nipples can occur for a variety of reasons, ranging from natural changes to underlying medical conditions. Understanding the causes can help you determine whether further medical attention is needed.

Ageing

As you enter your mid-30s, your breasts begin to undergo changes that continue with age. As you approach menopause, the milk ducts may shorten, which can sometimes cause the nipple to retract inward. Since the risk of breast cancer increases with age, it’s essential to consult your doctor if you notice any changes in your breasts.

Breastfeeding, Surgery, or Injury

If you’ve recently stopped breastfeeding, your nipples may turn inward due to scarring of the milk ducts. Similarly, breast surgery or an injury to the breast can also lead to nipple inversion.

Congenital Inverted Nipples

Some individuals are born with inverted nipples. This occurs when the base of the nipple remains small during development in the womb or when the milk ducts do not fully form, causing the nipple to pull inward.

Mammary Duct Ectasia

This condition, typically affecting women aged 45 to 55, involves the widening and clogging of the milk ducts. In addition to inverted nipples, symptoms may include:

• Redness around the nipple
• Tenderness
• Discharge that may be white, green, or black

Bacterial Infection (Mastitis)

Bacterial infections, such as periductal mastitis, can occur when bacteria enter the milk ducts. This is common in women who are breastfeeding or have recently given birth, but it can also affect those with cracked or pierced nipples. Symptoms may include:

• Tenderness, redness, or warmth in the breast
• Bloody nipple discharge
• A lump behind the nipple

Diagnosis may involve an ultrasound or a needle biopsy, and treatment typically includes antibiotics.

Subareolar Abscess

An infection in the glands beneath the areola can lead to the formation of a pus-filled abscess, which may cause the nipple to retract. This rare condition is often linked to smoking, nipple piercings, or diabetes. Treatment involves antibiotics and draining the abscess, either with a needle or through surgery.

Breast Cancer

Sudden inversion of one or both nipples can be a sign of breast cancer. Other symptoms may include:

• A lump or thickening in the breast
• Dimpling or other skin changes

Diagnosis may involve a combination of a breast exam, mammogram, ultrasound, biopsy, or MRI. Treatment options depend on the type and stage of cancer and may include surgery, radiation, chemotherapy, or hormone therapy.

Paget’s Disease of the Breast

A rare form of cancer affecting the nipple and areola, Paget’s disease is often associated with ductal carcinoma in the same breast. Symptoms include:

• Flattening of the nipple
• Pain, itching, or flaking skin
• Nipple discharge

How Are Inverted Nipples Treated?

If you’re concerned about inverted nipples and are considering treatment, it’s important to consult your doctor. The appropriate treatment will depend on the severity of the inversion and your individual circumstances.

Hoffman Technique

The Hoffman technique is a non-invasive exercise that may help if your nipples are flat or mildly inverted, particularly if you’re preparing for breastfeeding. Here’s how it works:

1. Place your thumbs on either side of the nipple base.
2. Press downward while gently pulling your thumbs apart.
3. Repeat this motion around all sides of the nipple.

This exercise encourages the nipple to protrude and may improve its appearance over time.

Nipple Eversion Devices

Your doctor may recommend using devices designed to gently pull the nipple outward. These include:

• Suction devices: Such as syringes or suction cups, which create a vacuum to draw the nipple out.
• Breast shells: Hard plastic shells worn inside your bra that apply pressure around the nipple, encouraging it to move forward.

These methods are non-surgical and can be effective for mild to moderate cases.

Surgery

For more severe cases, surgery is often the most effective treatment. During the procedure, the milk ducts are released to allow the nipple to protrude. However, if you plan to breastfeed in the future, discuss the potential risks with your surgeon, as the procedure may affect milk ducts.

3 Common Questions About Inverted Nipples Answered

Inverted nipples can raise many questions, especially if you’re concerned about their appearance or impact on breastfeeding. Here are answers to three frequently asked questions about inverted nipples:

1. How Can I Reduce My Risk of Flat or Inverted Nipples?

In most cases, flat or inverted nipples are congenital, meaning individuals are born with them. Unfortunately, there’s no way to prevent this. However, you can reduce the risk of complications, such as infections, by avoiding smoking. Research shows that most people diagnosed with periductal mastitis (a chronic breast tissue infection) are tobacco users. This condition can lead to symptoms like nipple inversion, among others.

2. Do Inverted Nipples Ever Go Away on Their Own?

Inverted nipples typically do not resolve on their own. If you’re concerned about their appearance or functionality, consult your healthcare provider. They may recommend:

• Surgical options for a permanent solution.
• Non-invasive methods like the Hoffmann technique, which involves gently stretching the nipple to encourage it to protrude.

Your provider will assess the cause and grade of inversion to recommend the most suitable short-term or long-term treatment.

3. Can Nipple Piercing Help Correct Inversion?

Some individuals opt for nipple piercings to help inverted nipples protrude more. The jewellery is thought to keep the nipple erect. However, this method:

• Does not work for everyone.
• Increases the risk of infection.
• Can be painful.

Additionally, nipple piercings are not recommended if you plan to breastfeed in the future. If you’re considering this option, discuss the potential risks and benefits with your healthcare provider beforehand.

Posted In: Body Treatments Blogs

Written By: Dr Azhar Aslam