Definition

An inverted nipple is a condition where the nipple is pulled inward. This causes the tip of the nipple to appear sunken or flush with the areola (the darker area surrounding the nipple). This condition can occur in 10-20% of the general population and can affect one or both breasts.

Both men and women can have inverted nipples. You may be born with this condition. However, if an inverted nipple develops later in life, it could be a sign of a medical condition that should be checked by a doctor.

Causes

Congenital Condition

In the womb, nipples develop during the third trimester. While in the womb, the nipples might not protrude and remain directed inward at birth. This occurs because the base of the nipple remains small during gestation or because the milk ducts do not develop properly. As a result, the nipple is pulled inward.

Aging Process

Starting in the mid-30s, your breasts will continue to change as you age. The milk ducts (lactiferous/mammary ducts) within the breast can shorten as menopause approaches. Sometimes, this can cause the nipple to retract. Since the risk of breast cancer increases with age, you should see a doctor if there are any changes to your nipples.

Breast Infections

Bacteria can enter the milk ducts and cause an infection. This condition, called periductal mastitis, primarily occurs in women who have recently given birth or are breastfeeding. Bacteria can also enter through nipple piercings or cracked nipples.

Symptoms that may result from a bacterial infection include:

• Pain, redness, and warmth in the breast
• Discharge mixed with blood from the nipple
• A lump was felt behind the nipple

If an infection occurs in the milk glands under the areola, a pus-filled lump (abscess) can form. This condition can also cause the nipple to retract.

We also have articles on cracked nipple that you can read here: Cracked Nipple - Definition, Cause and Risk Factor.

Risk Factor

Several risk factors can increase the risk of inverted nipples, including:

Paget's Disease of the Breast

This rare condition is associated with breast cancer and causes changes in the nipple and areola. In addition to nipple flattening, Paget's disease can cause pain, itching, peeling skin, and discharge from the nipple.

Mammary Duct Ectasia

The ducts that carry milk to the nipple can become dilated (ectasia) and clogged. This condition, called mammary duct ectasia, usually affects women between the ages of 45 and 55. One symptom of this condition is an inverted nipple. Blockages in the milk ducts can resolve on their own, but if not, antibiotics or surgery can be used to treat the condition.

Other factors that can increase the risk of inverted nipples include:

• Sagging breasts
• Fat necrosis in the breast tissue due to injury/trauma
• Breast infections
• Sudden weight loss
• Side effects of breast surgery
• One of the symptoms of breast cancer is a retracted nipple

Symptoms

Typically, nipples protrude outward. With inverted nipples, the nipples are drawn into the areola, making the tip of the nipple appear sunken or flush with the areola.

Inverted nipples can be classified into three grades based on severity:

• Grade 1: The nipple can be easily pulled out and sometimes protrudes on its own when stimulated or in cold temperatures. With grade 1 inverted nipples, you can still breastfeed your baby.
• Grade 2: The nipple can be pulled out but quickly returns to its original shape. You may have difficulty breastfeeding.
• Grade 3: The nipple cannot be pulled out, making breastfeeding impossible.

Diagnosis

Inverted nipples are usually noticeable at puberty. In many cases, inverted nipples that appear before puberty will correct themselves after a girl reaches puberty. This condition typically does not cause health problems. A doctor will examine the condition if the inverted nipple is accompanied by other symptoms that could indicate another disease.

To assess the severity of inverted nipples, your doctor will palpate the breast and nipple. If the inverted nipple appears after puberty and is accompanied by other symptoms, such as blood discharge from the nipple or a lump in the breast, it could be due to malignancy or another medical condition.

Therefore, your doctor may ask about your family history of breast cancer and any history of breast injury/trauma. Additionally, your doctor may perform other examinations, such as a breast ultrasound, mammography, breast tissue biopsy, and MRI, to determine the underlying cause of the inverted nipple.

Management

Inverted nipples that do not cause other symptoms generally do not require treatment. Treatment is provided if you feel that the condition is cosmetically concerning or interferes with breastfeeding.

Breastfeeding can itself be considered a treatment for inverted nipples, as the act of a baby sucking the nipple can release the adhesion causing the nipple to invert.

There is no specific standard treatment for inverted nipples. The doctor will evaluate the severity of the inverted nipples the patient has. Surgery is typically performed for persistent grade 2 and grade 3 inverted nipples.

Here are some treatment options for inverted nipples:

Hoffman Technique

This technique involves pressing both sides of the nipple on the areola with your thumbs. Then, you need to move your thumbs away from the nipple. This can help the nipple to protrude. This method can be used for mild inverted nipples to help you breastfeed effectively. However, do not use this technique without consulting your doctor, especially if the inverted nipple is potentially caused by an underlying disease.

Using Devices

Your doctor may suggest using suction devices, such as breast pumps or a syringe without a needle, to draw out the inverted nipple.

In most cases, inverted nipples are managed surgically. However, surgical procedures can disrupt the milk ducts, potentially affecting breast milk production in breastfeeding mothers. In some cases, the nipple may retract again after the procedure.

Complications

Inverted nipples are usually not dangerous and do not cause specific medical conditions. This condition also does not affect breast milk production, and mothers with inverted nipples should not stop breastfeeding their babies because of this.

However, in some cases caused by certain medical conditions, such as breast cancer, various complications due to those diseases can arise, such as bleeding and infection.

Prevention

There are no specific preventive measures for this condition. You may be born with inverted nipples or have other diseases that cause this condition.

When to See a Doctor?

See a doctor immediately if inverted nipples interfere with breastfeeding. You should also see a doctor immediately if there are signs and symptoms of another underlying condition, such as a lump in the breast and discharge mixed with blood from the nipple.

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