What is Inverted Nipple?
An inverted nipple is when the nipple is drawn inward, instead of pointing outward as it normally does. This can happen to both men and women and can be present from birth or develop later in life. The inverted nipple lies below the flat part of the breast surrounding the nipple (areolar plane), compared to a normal nipple which projects beyond this area. Having an inverted nipple may cause mental distress, and can also cause difficulties while breastfeeding. Up to 20% of women are born with at least one inverted nipple, and they might not experience any problems until they start breastfeeding. Some people may not like the cosmetic appearance of inverted nipples, or find it worrying. It’s important to note that an inverted nipple isn’t always a cause for concern and shouldn’t be mistaken for a sign of breast cancer.
What Causes Inverted Nipple?
Inverted nipples, meaning those that point inward instead of outward, can occur for various reasons. These include natural development issues from birth, sagging breasts, a condition where fat tissue in the breast is damaged (traumatic fat necrosis), infections like acute mastitis (breast tissue inflammation), duct ectasia (widened milk ducts), tuberculosis, rapid weight loss, after certain surgeries on the breast, as well as severe conditions like cancer and Paget’s disease of the breast (a rare type of cancer).
If someone has inverted nipples due to cancer, it’s because cancer cells have spread into the milk ducts. It’s extremely important these cases are identified accurately through detailed physical exams and cancer-related tests. This is because surgeries to correct inverted nipples can’t be done if this happens and might make a critical breast cancer diagnosis more complicated or delayed. If the inverted nipples are due to natural development issues or other non-dangerous causes, they can be fixed with surgery.
Risk Factors and Frequency for Inverted Nipple
Congenital nipple inversion, which is when someone is born with inverted nipples, can be seen in up to 10% of people. This condition affects both men and women. Interestingly, in about 87% of cases, both nipples are inverted, and in 50% of cases, there is a family history of this condition.
Signs and Symptoms of Inverted Nipple
An inverted nipple, which is naturally tucked into the breast, can be something a person is born with or it can develop over time as a result of age or a medical condition. For many often diagnosed in young individuals approaching puberty, the inverted nipples will correct themselves naturally as the individual goes through puberty. It usually doesn’t cause any issues and doctors will keep an eye on it until the person has completed adolescence to see if it resolves itself. However, if the condition doesn’t fix itself during this growth period, it probably will remain into adulthood. At this point, some adults might choose to get it corrected if it interferes with breastfeeding, affects self-esteem, or for aesthetic reasons.
However, if a nipple suddenly becomes inverted after a person’s breasts have already fully developed, it could be a sign of a serious condition, like cancer. Other signs that may accompany post-puberty inverted nipples and might signal a bigger problem include fluid coming from the nipple, a breast lump, or an abrasion on the nipple. If you’re showing these symptoms, it’s important for doctors to know your personal and family history of breast cancer. Doctors will also need to know if you have had any past injuries to the breast or chest, because scar tissue and damaged fat cells can sometimes look like cancer. Trauma-related conditions, however, typically don’t cause nipple discharge.
Testing for Inverted Nipple
An inverted nipple is a condition that a doctor can identify by simply looking and examining. Additional tests like mammograms, ultrasounds or ductoscopic evaluations (checking the milk ducts using a tiny camera) may be needed if the inverted nipples are also showing signs like discharge, abnormal widening of a duct, or suspicious for cancer. These tests can help find treatable causes behind the inverted nipples, such as lumps in the breast or infections.
Inverted nipples can occur in one or both breasts and can be present from birth or develop later. They can be categorized in different ways. A simple classification labels them as ‘umbilicated’ if they occasionally invert, and ‘invaginated’ if they stay inverted all the time. Another surgical classification determines them by the level of developed fibrous tissue (connective tissue that forms scars), their response to manipulation, and the amount of harm on the milk-producing ducts. This classification divides inverted nipples into three grades:
Grade 1 inverted nipples, also known as ‘shy nipples’, show little to no fibrous tissue and have enough healthy tissue. The milk ducts stay normal, despite the retraction. These nipples can be easily manipulated and keep their outward shape for a long time, making breastfeeding possible, even though it may initially be a bit difficult.
Grade 2 inverted nipples show a moderate amount of fibrous tissue. Inside the tissue, bands of smooth muscles are found around the fibrous part. The milk ducts are pulled inwards. The nipples can be pulled out but they return to their inward position quickly. Breastfeeding can still be possible, however, the baby may have trouble latching on to the nipple. The decision on whether to surgically cut the fibrous bands around the milk ducts varies from person to person. Most often, surgery is not required.
Grade 3 inverted nipples have a lot of fibrous tissue and a significant lack of normal soft tissue. The milk ducts are very small, tightened and extensively pulled inwards. From a microscopic point of view, the end of the ducts are scarred and have also shrunk. These nipples can’t be pulled out and often need surgical correction. Breastfeeding is almost impossible. Patients with these nipples can experience various related issues like rashes, sore nipples and regular breast infection.
Treatment Options for Inverted Nipple
The management of nipple inversion depends largely on the severity of the condition. There have been numerous surgical and non-surgical methods used over the years to treat nipple inversions, some giving satisfactory results, others not so much. For mild cases (grade 1), or partially with moderate cases (grade 2), non-surgical techniques are often used with considerable success, while more severe cases (grade 3) and persistent grade 2 inversions usually require surgical procedures. Even so, there hasn’t been a universally recognized and followed technique for the treatment.
Non-surgical or conservative methods primarily involve using certain devices that apply a gentle, continued suction on the nipple and surrounding area, helping to draw out and maintain the position of the nipple. Practices included a historic technique which involves applying firm pressure around the nipple and drawing away slowly, though a study in the 1990s determined that this could potentially harm milk ducts and interfere with breastfeeding, leading to its abandonment.
One non-surgical technique used for all grades of nipple inversion involved a homemade device fashioned from a single-use syringe. This helped to pull and lift the nipple. This method had success, particularly for grade 1 and 2 inversions, with one of the major benefits being the preservation of breastfeeding. Merchandise such as shells, cups, and specially designed suction devices have also been suggested, these work by pulling the nipple into a small cup. However, their long-term effectiveness hasn’t been proven yet. Piercing has also been explored as a potential solution, and the piercing’s position was usually maintained for a little over a year after its removal.
In comparison, surgical methods are typically reserved for grade 2 and 3 inversions. The goal of these procedures is to release fibers and milk ducts, and to add support beneath the nipple that will prevent it from inverting again. Various techniques have been used and they can be grouped into two categories: those that preserve the milk ducts, and those that can damage them. Anesthesia is usually all that is required for these procedures.
For the surgical techniques, two different, not overly complex methods have been used. The first one involves the creation of two small flaps of tissue attached to the base of the nipple. The second technique relied on creating three flaps of tissue to better support the nipple structure. A microscope was also found to be a useful tool in helping surgeons identify and carefully preserve the milk ducts.
Some methods used stitches to close the soft-tissue defect, which can occur after the nipple is repositioned. Other techniques have suggested the use of cartilage from the rib or ear to support severely or recurrently inverted nipples after initial correction. While these procedures have resulted in positive results, they can negatively affect breastfeeding and also result in the nipple having unnatural feel.
What else can Inverted Nipple be?
When a doctor is examining a patient with signs of nipple inversion, they need to consider several possible conditions that might be causing the symptoms. These symptoms may include things like skin breakdown, inflammation, redness, eczema, bloody nipple discharge, or a lump under the skin surface near the nipple.
So when the doctor is thinking about what might be causing nipple inversion in these cases they are going to consider several possible illnesses:
- Breast cancer
- Paget’s disease of the nipple (a rare type of cancer involving the skin of the nipple and areola)
- Erosive adenomatosis of the nipple (a rare benign lesion)
- Florid papillomatosis (abnormal growth of cells in the ducts of the nipple)
- Subareolar ductal papillomatosis (least aggressive type of papilloma)
- Breast eczema
- Changes due to surgery
- Fat necrosis (dead or damaged fatty tissue)
- Fibrocystic disease (noncancerous changes that can make your breasts feel lumpy)
- Mondor’s disease (rare condition involving a vein in the breast)
- Syringomatous adenoma of the nipple (a rare benign tumor)
- Nipple leiomyoma (benign smooth muscle tumor)
- Borrelia-associated lymphocytoma cutis (a skin condition linked to Lyme disease).
It’s the doctor’s job to work out which of these might be behind the symptoms so they can recommend the appropriate treatments.
What to expect with Inverted Nipple
Having inverted nipples from birth is usually not a harmful condition. How it affects a person depends on the severity of the nipple inversion and the treatment chosen. Mild cases (Grade 1) usually have good outcomes with non-surgical treatments. Once successful breastfeeding is achieved, the problem is normally resolved long-term.
Moderate cases (Grade 2) might not always respond well to these non-surgical treatments. If there’s no improvement or if the condition comes back, surgery could be an option. But it’s important to discuss this thoroughly with your doctor, focusing on future breastfeeding plans.
Possible Complications When Diagnosed with Inverted Nipple
Correcting inverted nipples is generally considered safe. After the procedure, patients may feel a bit of swelling and sensitivity, but these symptoms typically go away on their own. It’s rare, but sometimes there could be bleeding or an infection in the wound from the surgery. The most significant issue to be aware of is the chance that the nipple might invert again. This risk is most prominent between 6 to 12 months after the surgery.
Common effects and issues:
- Swelling
- Sensitivity
- Bleeding (rare)
- Infection in surgical wound (rare)
- Nipple re-inversion
Recovery from Inverted Nipple
After surgery, the wound is usually covered with a simple bandage and some antibiotic cream. It’s very important that patients avoid touching or poking the wound until it’s fully healed to prevent infection.
Preventing Inverted Nipple
Breasts and nipples are not only essential for breastfeeding but are also a significant part of how many women define their femininity. Some people have a condition where their nipples are inverted or turned inwards. This condition can impact a person’s confidence and how they perceive themselves. It can affect people at any age, including pre-teens, teenagers, and adults, all for different reasons. Children might notice that their nipples are different from their friends’, which can sometimes lead to bullying. As these children grow up and start having intimate relationships, they might find that their condition affects their love life.
It’s worth noting that some people know they have inverted nipples but aren’t bothered by it. That’s why when a patient seeks treatment to correct their inverted nipples, it’s important for their healthcare provider to understand why. They need to know if it’s the patient’s personal desire to have the procedure done, or if the patient feels external pressure to change something about themselves that they wouldn’t have otherwise thought of as a problem. These questions should be tackled before going forward with the treatment.
