Summary

• Flat nipples are a natural trait characterised by the nipple and areola being flush with the skin
• This can cause a loss of confidence in intimate relationships, breastfeeding difficulties and discomfort, in addition to being a cosmetic concern.
• Flat nipples can be caused by genetics, hormonal fluctuations, ageing and breastfeeding
• Although non-surgical treatments are available, corrective nipple surgery is the only permanent solution
• Cadogan Clinic’s team of expert Consultant Breast Surgeons are specialists in all areas of nipple correction surgery

When it comes to breasts, many women are aware of the choices that they have if they are unhappy. This could be due to the size of their breasts or the shape. Not everyone is quite so clear when it comes to nipples though. Flat nipples can often be a cause of psychological discomfort for women. It is important to realise that flat nipples are not a medical issue. They can present problems when it comes to breastfeeding at times, but generally, women seek a change for confidence or cosmetic reasons.

Breasts can be seen as part of a woman’s sexuality and the nipples are an extension of this, and perhaps more intimate. When women feel that their nipples perhaps aren’t as they would like, this can cause them distress and unhappiness. Flat nipples can cause women to feel uncomfortable around their partners or even when wearing revealing clothing such as swimwear. Additionally, flat nipples can cause functional concerns, such as breastfeeding difficulties or discomfort.  This often leads women to look into solutions for flat nipples, which we will explore below.

What Are Flat Nipples?

Flat nipples are not as rare as some women may believe. Around 10% of women, and men, have nipples that they are not happy with because they are either flat or inverted. What may be considered ‘normal’ nipples tend to protrude away from the breast. These nipples will react to being stimulated through breastfeeding, being sexually aroused, and cold temperatures. Flat nipples may also react in the same way and pop out when stimulated, but appear different when there is no stimulation.

Flat nipples are not raised. They lay even with the areola. They do not stick out, but they do not turn in either. Nipples that turn in are known as inverted. A way of establishing if you have flat nipples is to compress the areola. This should be done about an inch behind the nipple. If it doesn’t appear erect it means that you have flat nipples. Women often explore how to get rid of flat nipples as a way to boost their confidence and self-esteem. 

What Does a Normal Nipple Look Like vs a Flat Nipple?

It is important to remember that nipple appearance can naturally vary between individuals, and that in reality, there is not a single definition for a normal nipple. Understanding the appearance of a flat nipple compared to a typical nipple is important in determining specific concerns, such as breastfeeding difficulties.

The main difference between flat and normal nipples is that normal nipples protrude slightly from the surface of the breast, whereas flat nipples lie flush with the areola.

Our Expert Surgeon’s Insight

Consultant Plastic and Reconstructive Surgeon, Mr Manaf Khatib, discusses what flat nipples are and what you need to discuss with your surgeon if you are considering treatment for flat nipples.

What Causes Flat Nipples?

While flat nipples can be considered normal, women with these often like to know the reasons for them. Generally speaking, flat nipples are caused by a shortening in the milk ducts within the breast, causing the nipple to be pulled inwards slightly. However, there are several reasons that this trait can occur.

The only time that would be a cause for concern would be if your nipple begins to change for no apparent reason. If this happens you must consult a doctor immediately. This aside, the main causes are:

Being Born with Flat Nipples

Your nipples form during the time that you are in the womb. When women have flat nipples it is often from this time. It may be that the nipple has a small base or it could be linked to milk ducts. Milk ducts play a role in the development of your nipple. It may be that these don’t fully develop and pull your nipple inwards.

Ageing

It is common for women to experience changes to their bodies as they age. This includes both breasts and nipples. It is common to see changes to nipples from around your mid-30s. This is a time when milk ducts may shorten as you approach menopause and this can cause the nipple to invert or lay flat.

Breastfeeding

Breastfeeding can cause the appearance of flat nipples; however, this is typically temporary, and in most cases will resolve without further intervention.

During breastfeeding, it is normal for the skin around the nipples and areola to become swollen, resulting in the nipples appearing flatter than usual. Additionally, engorgement, where the breasts are too full of milk, can also cause the nipple to be pushed flat.

Hormonal Changes

Normal hormonal fluctuations in oestrogen and progesterone during puberty, pregnancy, menstruation and menopause can cause changes in the breasts and nipples, including the development of flat nipples. This is caused by the milk ducts shortening, resulting in the nipple sitting flat, or retracting.

Pagets Disease

This is an extremely rare condition. However, when it does present, it requires urgent medical attention as it is a form of cancer. As well as changes in how the nipple protrudes, women also experience pain, itchiness, flaking, as well as discharge. 

Frequently Asked Questions