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What are inverted nipples?

An inverted nipple is a nipple that is turned inwards into the breast rather than pointing outwards. Inverted nipples are mostly congenital and are not uncommon, affecting up to 20% of men and women. It may affect one or both sides.

Tagged: Body & Breast

Author: Mr. Bryan Mayou, MB ChB FRCS

Date: 7th February 2024

Medically Reviewed by:  Mr. Bryan Mayou (GMC: 1414396)

Last reviewed: 7th February 2024

What Are Inverted Nipples?

An inverted nipple is a nipple that is turned inwards into the breast rather than pointing outwards. Inverted nipples are mostly congenital and are not uncommon, affecting up to 20% of men and women. It may affect one or both sides. 

The problem is largely cosmetic, although in some women, it can make breastfeeding difficult or impossible. 

Some nipples are inverted at rest but will pop out with sexual, manual or cold stimulation. Others are permanently inverted. There is a variation of an inverted nipple that is referred to as ‘flat nipple’, where the nipple lies against the areola and neither protrudes nor inverts. 

What Causes Inverted Nipples?

The usual cause of nipple inversion is that the nipples are pulled inwards by short, tight milk ducts. Sometimes, gradual drooping of the breast tissue (ptosis) can occur faster than the ducts will stretch and the nipple inverts. 

Another cause is fibrosis caused by inflammation such as a breast abscess or chronic mastitis. 

Inverted nipples can also be caused by trauma, breastfeeding, breast infections or breast cancer. In some cases, genetics are a factor, and patients may simply be born with the condition. 
In some instances, it can also be caused by breast surgery, such as mastectomy or breast reduction, when the underlying breast structure is affected.  

However, if a previously normal nipple begins a turn in without reason, it may well signal a breast tumour beneath. This should be immediately reported to your doctor. 

What Are the Grades of Inverted Nipples?

Healthcare professionals categorize inverted nipples into different grades based on the degree of inversion, and to describe the severity of the condition. The grades are classified as: 

  • Grade 1 (Mild): the nipple can still be pulled out and protrudes with minimal stimulation and effort. Not severe.  
  • Grade 2 (Moderate): the nipple is inverted and requires material effort to be pulled out and protrude. The nipple retracts more easily after stimulation.
  • Grade 3 (Severe): the nipple is significantly inverted and it is hard to pull out and protrude the nipple. The nipple largely remains inverted at rest.  

Nipples can be affected unilaterally (just one side) or bilaterally (both), and to differing grades.  

How To Fix an Inverted Nipple?

There are a number of things that purport to fix inverted nipples, although surgery is the only way guaranteed to fix the problem. 

  • The Hoffman technique is a form of stimulation used for drawing out inverted nipples. It has been practised since the 1950s. This is not a long term solution. 
  • Suction devices, such as cups or shells, can stimulate the nipple and make it protrude.  However, there has been no research to back up whether these devices are fully effective. 
  • Some people claim nipple piercing can help to draw out inverted nipples. However, many people find this does not work, and the nipple may invert again once the body jewellery is taken out. 
  • The most effective treatment for inverted nipples is inverted nipple correction surgery, which we can carry out here at the Cadogan Clinic. 

What is Inverted Nipple Correction Surgery or Nipple Repair Surgery?

Inverted nipple surgery, also known as nipple correction surgery or nipple repair surgery, is a cosmetic procedure that seeks to correct inverted nipples.  

The aim of the surgery is to ‘evert’ the nipples, or bring them outwards, from their resting inverted state. The overall idea is to improve the appearance of the nipple as well as maintain or improve their functionality.  

The surgery is straightforward and is typically performed under local anaesthesia by a plastic surgeon or a specialized ‘oncoplastic’ breast surgeon, and takes under an hour.  

Techniques involved vary by the severity of the inversion and the individuals anatomy. Typical approaches include: 

  • Excision of Nipple Tissue: the procedure targets tissue at the base of the nipple to remove it and ‘unlock’ the nipple to enable it to protrude outwards.  
  • Suturing: sutures are used to build out tiny support structures in the supporting breast tissue to anchor the nipple in an everted position, and prevent it from inverting on itself. 
  • Tethered Duct Release: often the cause of the inverted nipple is tight milk ducts that tug the nipple inward into the breast tissue. These can be untethered by the surgeon surgically.  
  • Grafts or Flaps: in rare cases where the inverted nipple is Grade 3 (severe), grafts and flaps may be employed to introduce additional tissue support to ensure the nipple remains in its newly elevated position.  

How Long is Inverted Nipple Correction Surgery Recovery?

The surgery is minor and done under local anaesthesia, typically taking no longer than an hour.  

Recovery time varies but is typically short. You can expect some swelling, bruising, and discomfort for a short period, and it may be that certain clothes work best in the immediate recovery phase.  

As with all cosmetic procedures, it is, of course, essential to follow post-operative care instructions provided by the surgeon to ensure the swiftest possible recovery. 

You can expect an inverted nipple surgery aftercare timeline as follows:

  • Week 1: you will be ready to resume daily activities a day or two post surgery. You should avoid strenuous exercise such as heavy lifting and hard exercise. The general rule is to remain cautious in your activities at this preliminary phase as your swelling and bruising begin to subside and your healing process begins. Supportive bras and garments may be recommended to restrict unnecessary movements and expedite your healing process 
  • Week 2 – 3: you are now ready to return to work and your regular daily activities, so long as your job does not involve overly active movements. You should consult your surgeon for advice on this. You should expect a full recovery within this phase but continue to take care when it comes to exercise and physical activity. It is critical that the area remains protected in this phase   

Can I Expect Scars From Inverted Nipple Surgery?

Scars are small from nipple correction surgery and will continue to fade over time. 

Should I Consider Nipple Correction Surgery to Correct My Inverted Nipple?

Yes, you should consider nipple surgery to correct your inverted nipple if your surgeon indicates that a surgical approach will yield the best results. 

There are many benefits to inverted nipple correction surgery that include: 

  • Improved Aesthetic Appearance: your nipples will project outwards after surgery, creating a more natural breast appearance.   
  • Psychological Boost: as with many cosmetic procedures, successful nipple correction surgery can significantly boost a sense of wellbeing and self esteem, as well as generate a more positive body image. 
  • Symmetry: in cases where the nipple inversion is unilateral or imbalanced, nipple correction surgery can restore breast symmetry.
  • Wear New Clothes/Swim in Public: many people report a new found confidence to wear different clothing styles with the restoration of their nipple projection, and in many cases for inverted nipples on a man, go bare chested in public e.g. at the beach, or pool. 

It is also important not to overlook functional benefits, as well as the cosmetic. While the primary focus is often on the cosmetic aspect, correcting inverted nipples may also have functional benefits.  

  • Alleviate Discomfort: Some individuals may experience discomfort or sensitivity related to inverted nipples, and surgery can help alleviate these issues. Yes, if your consultant recommends it.
  • Enable breastfeeding/improve breastfeeding: Some women with inverted nipples may find breastfeeding challenging due to difficulties with latching. Nipple correction surgery may help address these challenges. 

Should I Consider Inverted Nipple Surgery If I Want to Breastfeed?

Inverted nipples on women still need to breastfeed following childbirth, and throughout pregnancy, all nipples tend to become more prominent in preparation. The good news is that this will enable a proportion of inverted nipples on women to correct themselves naturally. 

There are also clever gadgets called Niplettes, which, when applied over the nipple, gradually evert it by suction. This often works for a less severe problem. If you do want to breastfeed, then Nipplettes are the first call. If the nipple will evert with stimulation, then this is encouraging.  

More severe inverted nipples on women may require nipple repair surgery, and this can be done in such a way as to preserve a woman’s ability to breastfeed. That said, this is dependent both on the technique and the timing of the surgery. 

Your surgeon will need to adopt a technique that preserves the milk duct system in order to preserve their functionality. You will also need sufficient time to recover before breastfeeding.

Can I Expect Inverted Nipples After Menopause?

Menopause is not directly linked to inverted nipples, but it is possible that hormonal changes might prompt changes in your breast tissue and potentially impact the overall appearance of your breast and nipple area.

What is the Meaning of Inverted Nipple? Can It Be Serious?

Inverted nipples rarely carry much meaning but, on rare occasions, can be associated with breast cancer. If you are worried about any sudden changes in your nipple size, shape, or appearance, get in touch with a healthcare professional immediately.

What Percentage of Inverted Nipples Are Due to Breast Cancer?

The vast majority of inverted nipple cases are caused by factors other than cancer, such as genetics, trauma and inflammation. 

Whilst inverted nipples rarely indicate cancer, it is true that changes in the appearance of the breast can indicate cancer, so if you do notice sudden changes to your breast and nipple shape, you should speak to a provider immediately. 

How Do You Know If You Have Inverted Nipples?

Nipple inversion isn’t considered a cause for concern if it has been present since childhood or puberty or if it has happened gradually over the course of several years. It can occur in pregnancy and in breastfeeding women. Women who are pregnant for the first time are particularly prone to nipple inversion. 

Inverted nipples can make breastfeeding difficult as it is harder for the baby to latch on for feeding. 

If a woman’s nipple suddenly changes in appearance, including sinking into the breast, then she should go to a doctor, as this can be a symptom of breast cancer. 

What is an Inverted Nipple Corrector?

An inverted nipple corrector is a non-invasive device designed to address inverted or retracted nipples. It applies gentle pressure via a cup-like structure to create a vacuum to pull the nipple outward. While they do work for certain conditions, you should take advice from a healthcare professional to determine their suitability.  

Whatever your requirements, the Cadogan Clinic can provide the leading breast experts and techniques for your treatment at our state-of-the-art facility in order to achieve your desired aesthetic and a better-proportioned nipple, be they inverted, flat or puffy nipples.

Book a consultation today to discuss the best treatment option for you. 

Words From Our Founder

Mr. Bryan Mayou

Inverted nipples can not only cause physical discomfort but also deeply affect one's confidence, particularly in intimate relationships. Fortunately, a simple procedure, typically performed under local anesthesia and lasting less than an hour, can offer a permanent solution. By releasing the tissue underneath the nipple, we restore the nipple's natural shape, alleviating potentially years of self-consciousness.
Mr. Bryan Mayou

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