An inverted nipple describes a condition where the nipple, instead of extending outwards, retracts or pulls inward into the breast. This anatomical variation can affect one or both breasts and is generally considered a common occurrence. It may be present from birth, known as congenital inversion, or develop later, referred to as acquired inversion.
Understanding Nipple Inversion
Nipple inversion is categorized into different grades, reflecting the severity of the retraction and the nipple’s ability to evert, or protrude. Grade 1 inversion, often called “shy nipples,” is the mildest form where the nipple can be easily pulled out with gentle pressure or spontaneously evert with stimulation or cold. These nipples typically maintain their outward projection and involve minimal tissue fibrosis.
Grade 2 inversion represents a moderate degree of retraction; the nipple can be pulled out, but quickly retracts back inward once pressure is released. This indicates a moderate amount of fibrous tissue pulling the nipple. The most severe form is Grade 3 inversion, where the nipple remains deeply retracted and cannot be pulled out even with significant effort. This grade is associated with extensive fibrosis and significantly shortened milk ducts.
Common Reasons for Nipple Inversion
Many instances of nipple inversion are benign and do not indicate a serious health concern. Genetic predisposition is a frequent cause, with some individuals born with inverted nipples due to naturally tight connective tissue or underdeveloped milk ducts.
Nipple inversion can also develop over time due to various physiological changes. Hormonal shifts during puberty, pregnancy, or menopause can affect breast tissue and potentially lead to nipple retraction. As a person ages, milk ducts may naturally shorten, contributing to an inward pull of the nipple. Additionally, temporary flattening or inversion can occur during pregnancy or breastfeeding as breasts fill with milk, often resolving once breastfeeding concludes. In some cases, benign breast conditions, breast injuries, scarring from previous surgeries, or mammary duct ectasia (clogged milk ducts) can also result in nipple inversion.
When Nipple Inversion Can Be a Concern
While often harmless, a newly acquired nipple inversion, especially if it affects only one breast, can signal an underlying health issue that requires prompt medical attention. It is important to seek evaluation if the inversion is accompanied by additional symptoms. These signs can include pain or tenderness in the breast, or redness and inflammation of the nipple or surrounding skin.
Any nipple discharge, particularly if bloody or yellowish, should also be evaluated by a healthcare professional. Changes to the breast skin, such as dimpling resembling an orange peel, puckering, a rash, or flaking or crusty skin around the nipple, are also indicators. Furthermore, a palpable lump in the breast or armpit alongside a new nipple inversion warrants immediate medical assessment.
These symptoms could indicate various underlying conditions. Infections or inflammatory processes, such as periductal mastitis or an abscess, can cause nipple retraction. In some cases, a new or changing nipple inversion can be a symptom of breast cancer, where a tumor behind the nipple pulls on the milk ducts. Paget’s disease of the breast, a rare type of cancer affecting the nipple skin, can also present with nipple inversion and skin changes.
Nipple Inversion and Breastfeeding
Nipple inversion can sometimes present challenges for infants attempting to latch during breastfeeding. The degree of difficulty often correlates with the grade of inversion; while Grade 1 typically poses few issues, Grade 2 can make latching harder, and Grade 3 can be very challenging. Despite these potential difficulties, many women with inverted nipples successfully breastfeed.
Several strategies and tools can help facilitate breastfeeding. Manual stimulation, such as gently rolling the nipple between the fingers or applying cold, can encourage the nipple to protrude. Briefly pumping before a feeding can also help draw the nipple out, making it easier for the baby to latch.
Nipple shields, thin silicone covers placed over the nipple, can provide a more pronounced shape for the baby to grasp. Breast shells, worn between feedings, are another option thought to coax the nipple outwards, though effectiveness varies. Utilizing different breastfeeding positions, such as the side-lying or football hold, can also improve latching. Consulting with a lactation consultant can provide personalized guidance and support to overcome breastfeeding challenges.
Options for Nipple Inversion
For individuals seeking to address inverted nipples, whether for cosmetic reasons or to aid in breastfeeding, various approaches are available. Non-surgical methods include suction devices, such as the Niplette, which create a vacuum to gently draw the nipple outwards. These devices require consistent use over time and are generally more effective for milder cases. Nipple piercing, which applies traction to the nipple, is another non-surgical consideration, though piercings may interfere with milk ducts. Dermal fillers can also offer a temporary solution by adding volume around the nipple.
Surgical correction involves minor procedures performed to release the tight fibers or constricted ducts that pull the nipple inward. During the procedure, a small incision is typically made at the base of the nipple, allowing underlying tissue to be released and the nipple to be repositioned to protrude outwards. The nipple is then re-stitched to maintain its new position. These procedures can be performed under local or general anesthesia.
Surgical correction, particularly if milk ducts are cut, may impact the ability to breastfeed. A thorough consultation with a medical professional is essential to discuss the most suitable options based on individual circumstances and goals.