Nipple Inversion


An inverted nipple is retracted into the areola and breast. Inverted nipple is a cosmetic problem that does not pose any risk, but in some cases, it may cause difficulty in breastfeeding.

The main cause of inverted nipple is shortening of the milk ducts and the fibrous connective tissue between the milk ducts. In addition, there can be a deficiency of supporting soft tissue underneath the nipple.

There are 3 Grades of Inverted Nipple Severity. While grade 1 and grade 2 can be easily corrected easily, grade 3 needs a surgical correction in which a patient might not be able to breastfeed and may also loose nipple sensation.

Grade I

In grade I, the inverted nipple can be pulled out and stays everted without traction for a long time. There is minimal fibrosis and no soft tissue deficiency. This can usually be treated by a suction type device or even short-term nipple piercing. If these non-surgical methods fail, a simple surgical procedure that places a purse-string suture around the base of the nipple can solve the problem. No ducts are divided.

Grade II

In grade II, the nipple can be everted but not as easily and tends to retract. There is some fibrosis, the ducts are shortened but usually do not need to be divided for correction. Surgery is usually required. The fibrous tethering tissue is divided but the milk ducts are preserved.

Grade III

Grade III is the most severe, because the nipple usually cannot be everted. If it is possible to evert, the nipple will immediately retract. There is a high degree of fibrosis and the milk ducts are very short and retracted. In addition, there is usually a deficiency of soft tissue underneath the nipple. Correction requires surgery to divide all the tethering tissue including the milk ducts. Local flaps are also used to provide a bulk of soft tissue under the nipple. Although this will typically solve the problem, the patient will not be able to breast feed and may lose nipple sensation.

All surgeries for this condition are usually performed under local anesthesia.

After Inverted Nipple Correction

The recovery is straightforward with mild discomfort. For Grade I procedures, a non-bulky dressing is used. For Grade II and III repairs, usually a bulky gauze dressing or a plastic “dome” is used to prevent pressure on the nipple and protect the repair, for one to two weeks. The results vary according to how aggressive the release is. Assuming the release is aggressive enough for the patient’s condition, the relapse rate is about 3% although some studies with short follow-up show no relapse at one year.