Nipple inversion is when the nipple is abnormally placed below the areola,[1] turned inward or lying flat. Nipple inversion can also be referred to as retracted nipples. It can happen in one nipple or both. Many people aren’t aware that Nipple Inversion Surgery is available. People are usually born with them, but it could also be a sign of a medical problem that a doctor needs to check if you come into it later. That’s right. The world isn’t the only thing that’s upside down.
Continue reading to find out if you or a loved one has inverted nipples. Reach out to Dr. Justin Booth for a consultation to see if you are an ideal candidate for Nipple Inversion Surgery. Dr. Booth brings years of extensive training in cosmetic and reconstructive plastic and general surgery to Austin and the surrounding communities. His practice gives clients the highest quality experience and beautiful results, leaving them looking and feeling their best. We look forward to unveiling the new you to the world.
Levels of Nipple Inversion
- Grade 1
- Nipple can easily be pulled outward at this level and can sometimes stand on its own through cold or stimulation.
- Women can still breastfeed at this level.
- Grade 2
- Nipple can still be pulled outward but will quickly go back to its inverted form.
- Women may have difficulty breastfeeding at this level.
- Grade 3
- The most serious condition.
- Women may not be able to pull them out or breastfeed at all.
Causes of Inverted Nipples
- Genetics
- Sometimes the nipple base stays small while developing in the womb.
- Another possible cause could be underdeveloped milk ducts.
- Aging
- Your breasts start to change in your mid-30s, causing milk ducts to shorten, which can pull the nipples inward sometimes.
- Breastfeeding, Surgery, or Trauma
- Nipples can turn inward after breastfeeding due to scarring of the milk ducts.
- Having breast surgery or injuries to the breast can also cause inverted nipples.
- Mammary Duct Ectasia
- Typically affects women between 45 and 55.
- Causes the milk ducts to widen and clog up.
- Can cause tenderness, redness on or around the nipple, and a white, green, or black discharge.
- If the situation does not heal itself, the nipples may need antibiotics and possible surgery to unclog the duct or surgical removal.
- Breast Cancer
- If your nipples become inverted later in life, this could be a sign of breast cancer.
- Other symptoms include lumps and thickness in the breast and dimples and other breast skin changes.
- Bacterial Infection (Mastitis)
- Periductal mastitis is when bacteria get into the milk ducts and cause infection.
- It’s normal in women who have just given birth and are breastfeeding.
- It can also happen to women who only have a cracked or pierced nipple.
- Other possible symptoms are tenderness, redness, a high temperature in the breast, bloody nipple discharges, or a lump behind the nipple.
- Abscess Under Areola
- Infections under the areola in the glands can create an area filled with pus, retracting the nipple.
- Can be linked to smoking, diabetes, or pierced nipples.
- Paget’s Disease
- Rare kind of nipple and areola cancer.
- Can cause pain, flaking skin, itching, and discharge.
Treatment Of Inverted Nipples
Fortunately, the procedure to correct nipple inversion is simple. First, a sequence of specific stitches is placed around the nipple to drive it out and provide a balanced platform with minimal scarring. For their comfort, surgery is performed while the patient is under local anesthesia. Dr. Booth can finish the process in an hour or less.
No single technique is universally suitable for Nipple Inversion Surgery because different types have contrasting levels of fibrous tissues.[2] Although surgical repair has developed significantly over the years, studies have shown little data regarding recurrence rates, complications, and the demographics of patients seeking this type of surgery.[3]
Benefits
While inverted nipples usually do not pose many health concerns, they can cause patients to be insecure about their appearance, especially during intimate situations with loved one or partner. In addition to creating a better self-image in patients, Nipple Inversion Surgery can help ease potential breastfeeding complications.
Candidates
The ideal candidate for surgery is at least eighteen years of age, born with inverted nipples or has developed them through breastfeeding or injury. Candidates should not be pregnant or breastfeeding.
Preparation
Minimal preparation is needed since it is performed under local anesthesia. Dr. Booth will recommend that you quit smoking during the month of your procedure to help improve healing.
Procedure
First, Dr. Booth will make a small incision to the lower nipple, lift it, and sever the binding tissue. Next, he will create a series of cross-stitching to support the bulge of the nipple.
Surgical Techniques
There are two options for Nipple Inversion Surgery, both of which are simple and can be performed on an outpatient basis:
- Parachute-Flap Technique
- Leaves part of the milk ducts intact and will usually allow breastfeeding, but it’s not guaranteed.
- Detached-Duct Technique
- Eliminates possibility of breastfeeding.
- Usually reserved for more serious cases and involves detaching the milk ducts entirely.
Sometimes, the nipple will be suspended for a couple of days to assist the nipple’s emergence. Surgery does not alter the size, shape, or location of the breast.
There is much dilemma as to whether to separate the ducts or not.[4] This is something you and your surgeon must go over during your consultation.
Recovery
Usually, patients can return to work the following day, but it’s recommended not to exercise for one to two weeks. By that time, any visible swelling or bruising should have subsided. Following surgery, check back with your Dr. Booth in about two weeks so that he can monitor the healing process. While you heal, be sure to sleep on your back. Side effects include bruising and swelling. The shape of the nipples can change over time, so the patient may not entirely see the final results for a few months.
Results
Results may vary from person to person, but the expected permanent results are more proportional and symmetrical-looking breasts.
Complementary Procedures (optional)
- Breast Augmentation
- Breast augmentation is a surgical procedure that enhances a patient’s breasts to achieve a stunning appearance based on their desired outcome.
- Breast Reconstruction
- Breast reconstruction is a cosmetic remedy that addresses the loss or diminishment of one or both breasts.
- Mommy Makeover
- Mommy Makeover is a term that encompasses several aesthetic procedures that add up to a comprehensive enhancement for new moms.
FAQ
Approximately 20 to 30% of women have inverted nipples. They’re more common than you think.
If you are born with inverted nipples, then the chance of it being a cancer sign is minimal to none. However, if you get inverted nipples later on in life, then it is recommended you see a doctor as soon as possible.
All surgical procedures carry some degree of risk. You and your doctor need to go over them in preparation for your surgery. Some of these possible risks are:
• Infection
• Loss of sensation
• Inability to breastfeed
• Negative reactions to anesthesia
Surgery will usually take one or two hours, depending on the technique used and the inversion level of the nipples.
Nipple Inversion Surgery has a high success rate, and re-inversion is not common, though there have been some cases of it occurring in patients months or years after surgery.
Patients are given local anesthesia and will be offered a sedative during surgery. There will be some soreness after surgery, but it should go away in a couple of days. Medication can treat any additional pain.
Yes, you can pursue both at the same time.
If the milk ducts have not been completely removed, then yes.
Yes, surgery provides a permanent solution to inverted nipples.
This procedure is typically viewed as cosmetic by most insurance companies, so we recommend contacting your provider directly before pursuing surgery.
References
- Durgun, M., Özakpınar, H.R., Selçuk, C.T. et al. Inverted Nipple Correction with Dermal Flaps and Traction. Aesth Plast Surg 38, 533–539 (2014). https://doi.org/10.1007/s00266-014-0317-3
- Michael J. Lee, MD, Patricia A. DePoli, MD, Laurie A. Casas, MD, Aesthetic and Predictable Correction of the Inverted Nipple, Aesthetic Surgery Journal, Volume 23, Issue 5, September 2003, Pages 353–356, https://doi.org/10.1016/S1090-820X(03)00209-7
- Gould D.J., Stevens W.G. (2018) Correction of the Inverted Nipple. In: Shiffman M. (eds) Nipple-Areolar Complex Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-319-60925-6_39
- Terrill, P., & Stapletoa, M. (1991). The inverted nipple: To cut the ducts or not? [Abstract]. British Journal of Plastic Surgery, 44(5), 372-377. doi:https://doi.org/10.1016/0007-1226(91)90152-A