Inverted Nipples

What Are Inverted Nipples?

Inverted nipples are nipples that point inward or lie flat, rather than pointing out. It’s also called retracted nipples. It can happen in one breast or both. You may have been born this way. But if it starts to happen later in life, it could be a sign of a medical problem that needs to be checked by a doctor.

Grades of Nipple Inversion

Nipple inversion is classified by grades, based on how serious the condition is.

  • Grade 1. The nipple can easily be pulled outward, and will sometimes stand out on its own with cold or stimulation. You can still breastfeed.
  • Grade 2. The nipple can be pulled outward, but it quickly goes back to its original shape. You may have trouble breastfeeding.
  • Grade 3. The condition is most severe. You may not be able to pull the nipple out at all or breastfeed.

Causes of Inverted Nipples

Aging

Beginning in your mid-30s, your breasts start to change, and they keep changing as you get older. Your milk ducts shorten as you get closer to menopause. Sometimes this causes your nipple to move into your body.

Because the chances of getting breast cancer increase as you get older, it's important to check in with your doctor any time you notice a change.

Breastfeeding, breast surgery, or injury

If you've recently finished breastfeeding, your nipples might turn inward. This happens if the milk ducts scarred while you were breastfeeding. Breast surgery or other injury to the breast can cause your nipple to turn inward too.

Born with inverted nipples

Your nipples formed when you were in the womb. If they pointed inward when you were born, it's because your nipple base stayed small in the womb or your milk ducts didn't fully develop. That pulls your nipple inward.

Mammary duct ectasia

The ducts that carry milk to your nipples can widen and become clogged. This condition, called mammary duct ectasia, usually affects women between the ages of 45 and 55.

In addition to inverted nipples, you may also have:

  • Redness on and around your nipple
  • Tenderness
  • White, green, or black discharge

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The blocked milk duct may clear on its own. If it doesn't, treatments include antibiotics to unclog the duct or surgery to remove it.

Bacterial infection (mastitis)

Bacteria can get into your milk ducts and cause an infection. This condition, called periductal mastitis, is especially common in women who have just given birth or are breastfeeding. Bacteria also can get into the nipples of women who haven't given birth but have cracked or pierced nipples.

If your nipple becomes inverted due to a bacterial infection, you may also have symptoms such as:

  • Tenderness, redness, or a hot feeling in your breast
  • Nipple discharge that could be bloody
  • A lump behind the nipple

To make a diagnosis, your doctor may do an ultrasound or use a needle to collect cells from the infected area.

The most common treatment is antibiotics, though your body may heal itself over time.

Abscess under the areola

An infection can also happen in the glands under the areola and form an area filled with pus called an abscess. This can retract the nipple. It’s rare, and usually associated with smoking, nipple piercing, or diabetes. You’ll get antibiotics and have the abscess drained, either with a needle or surgically.

Breast cancer

If one or both of your nipples suddenly become inverted, it could be a sign of breast cancer.

You may also notice:

  • A lump or thickness in your breast
  • Dimples or other skin changes on your breast

Your doctor may use a combination of procedures to diagnose the issue, including a breast exam, mammogram, breast ultrasound, biopsy, and MRI.

Treatment depends on the type and stage of breast cancer. The options include things like surgery to remove the lump or the entire breast, radiation, chemotherapy, and hormone therapy.

Paget’s disease of the breast

This is a rare kind of cancer that happens in your nipple and areola. Most women who get it also have cancer in a milk duct in the same breast. Besides flattening the nipple, Paget’s disease can cause pain, itching, flaking skin, and discharge from the nipple.

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Treatment of Inverted Nipples

Talk to your doctor if you have concerns about your nipples and want to consider treatment. A lot depends on how severe the inversion is.

  • Hoffman technique. This exercise can be useful if your nipples are flat or mildly inverted and you want to get ready for successful breastfeeding. You place your thumbs on either side of the base of the nipple and press downward while pulling your thumbs apart. Work your way around to all sides of the nipple. Your nipple should then stand out.
  • Nipple eversion devices. Your doctor may suggest pulling the nipple outward with a syringe or suction cup device. Hard plastic breast shells worn inside your bra put pressure around the nipple, forcing it forward.
  • Surgery. The treatment for most inverted nipples is surgery. If you plan to breastfeed in the future, talk to your surgeon about the risk that the operation might harm your milk ducts. Also, keep in mind that some nipples go back to being inverted even after the procedure.
WebMD Medical Reference Reviewed by Brunilda Nazario, MD on September 14, 2020

Sources

SOURCES:

HealthyWomen: "Parenting Q&A."

Oxford Academic Aesthetic Surgery Journal: "Inverted Nipple Repair Revisited: A 7-Year Experience."

Breast Health & Healing Foundation: "Does One Inverted Nipple Increase the Chances of Breast Cancer?"

National Health Service (UK): "Breast Changes in Older Women," "Mastitis."

CDC: "What Are the Risk Factors for Breast Cancer?"

Mayo Clinic: "Mammary duct ectasia," "Breast cancer."

Breast Cancer Care: "Periductal mastitis."

Cancer Council Victoria: "Common Breast Problems."

UpToDate: “Nipple inversion.”

Icahn School of Medicine at Mount Sinai: “Subareolar abscess.”

 Breastcancer.org: “Subareolar/Periareolar Infection,” “Paget’s Disease of the Nipple.”

National Cancer Institute: “Paget Disease of the Breast.”

La Leche League GB: “Inverted nipples.”

Johns Hopkins Medicine: “Flat or Inverted Nipples.”

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