What are inverted nipples?

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 patients may be born with the condition.

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.

Should I consider nipple surgery to correct my inverted nipple?

You should consider nipple surgery to correct your inverted nipple if they are causing confidence and self-esteem issues. While nipple inversion correction is often purely cosmetic, the aesthetic nature of the procedure does not undermine its value or importance.

When it comes to nipples, there are many variations and there is no right or wrong shape. Although protruding nipples are considered the aesthetic standard, there is no medical reason to correct nipple inversion, except to allow breastfeeding (though, as noted above, nipple inversion can be a sign of a medical issue).

Nipples are there to breastfeed and throughout pregnancy, all nipples tend to become more prominent. This will enable a proportion of inverted nipples to correct themselves.

There are clever gadgets called Niplettes which applied over the nipple gradually evert it by suction. Try this, it often works in a less severe problem.

Should I consider inverted nipple surgery if I want to breastfeed? 

If you do want to breastfeed, then Nipplettes are the first call. If the nipple will evert with stimulation, then this is encouraging. Slightly more complicated surgery can still be successful even if the nipple is permanently inverted.

If you know that you will not want to breastfeed then surgery is more straightforward as milk ducts can be cut.