Inverted nipples occur when the nipple retracts into the breast instead of pointing outwards. Up 10–20% of women have it to some degree and it may also occur after rapid major weight loss.
Importantly, if it appears suddenly, you should attend a Breast Clinic without delay, particularly if associated with any lump or discharge.
The nipples are pulled in by a combination of short ducts and fibrosis and three grades are recognised, based on ease of correction and degree of fibrosis.
Grade 1 nipples evert spontaneously or with minimal manipulation. Although projection may be maintained, retraction is usually spontaneous. These ‘shy nipples’ have minimal fibrosis and non-contracted lactiferous ducts so breast feeding is often possible.
Grade 2 indicates a nipple which can be pulled out, though not as easily as grade 1, but retracts after release. Breast feeding is generally either difficult or impossible as there is a moderate degree of fibrosis. The ducts are mildly retracted and usually need to be divided for adequate release.
Grade 3 are severely inverted and retracted nipples, which are rarely, if ever, seen. everted without surgery. Th milk ducts are constricted, fibrosis is severe and breast feeding impossible. Women may also struggle with infections, rashes and nipple hygiene. The nipple tissue itself is also usually underdeveloped so even surgical release may not produce much of a projection.
More questions about inverted nipple surgery?
Before considering surgery other options have often be considered. Most women will have tried suction devices such as Avent’s Niplette, but its success is limited by the shortness of the cords.
Treatment of inverted nipples is usually performed under local anaesthetic (LA), which stings momentarily during injection, but rapidly numbs the area to allow pain-free surgery.
The 2 main options are:
- Peri-nipple incision with duct stretch and/or division leaving a small (2 mm) scar. This is reliable, with satisfactory treatment in 95%. Should recurrence occur, the operation may simply be repeated or a ‘flap’ technique used.
- Areolar flaps are used to provide a hammock beneath the nipple. Whilst almost entirely certain, it leaves visible scars on the areola and breast-feeding will be impossible.
Both techniques use absorbable sutures, which disappear over the following weeks.
Sponge dressings will be used to prevent the nipples being pressed back in. They should be left untouched and kept dry for a week.
You should avoid strenuous exertion for 1 – 2 weeks. There will be some discomfort as the anaesthetic wears off, but paracetamol is very useful and should be taken as soon as pain appears. Bruising is rare and the majority are back at work within a week of the operation.
Overall healing and recovery time is 4 – 6 weeks.
The ability to breastfeed cannot be guaranteed after any surgery to correct inverted nipples. Therefore, you should give careful consideration to surgery if wishing to breastfeed in the future. The milk ducts, which carry the milk from the underlying breast glands to the nipple, are lengthened or cut during the operation.
Any operation carries the risk of complications (including infection, bleeding and alterations in sensitivity). These are rare with modern techniques, but recurrence can be disappointing. This indicates a retraction of the nipple and is more common the more severe the grade: almost unheard of in Grade 1, it may appear in up to 1-in-25 Grade 3. Usually, a simple repeat procedure is sufficient, but areolar flaps may be suggested 2nd time around.
