Inverted Nipples

An inverted nipple is defined as one that does not protrude, and it can affect men, too. Rather than pointing outward, like an attachment to the top of the breast mound in the centre of the areola, it remains retracted within the areola.

The cause, anatomically speaking

The skin of the nipple is connected to the breast ducts, and these ducts connect to the breast gland that is responsible for milk production in females. When the breast ducts are overly short, they pull the nipple skin inward, causing inversion

An inverted nipple may or may not protrude when stimulated. This can be visible in one or both breasts and may negatively affect appearance.

Two types of inversion

There are two types of unprotruding nipples. If we want to get technical about it, these types are called inverted and retracted. Inverted nipples are when the entire nipple does not protrude and is pulled inward into the breast. Retracted nipples are when only a small slit of nipple is pulled inward.

Inverted nipple classification

Inverted nipples can vary in severity, and are ranked from one to three.

Grade 1: Mild or Slight
As the mildest type of inverted nipple, this grade is defined as a nipple that is flat or just slightly inverted. With stimulation from temperature or touch, the nipple will protrude to a certain extent and remain that way for a while before returning to its original flattened or slightly inverted state. The nipple may also be coaxed out by gently pinching the skin in the area. Typically, there are no breastfeeding issues.

If you have grade 1 inverted nipples, it can usually be corrected with non-surgical methods. One popular device, available at any drugstore, is a specially designed suction cup that gently stretches the milk ducts over time, allowing the nipple to come out. Some women also have success with a breast pump, the same kind that is used to pump milk.

Grade 2: Moderate
Nipples with grade 2 inversion appear more inverted. While they do protrude when stimulated, much like grade 1, they return to their inverted state immediately after being stimulated. There may be more difficulty manually releasing the nipple as well. Again, no breastfeeding issues are usually experienced.

If you have grade 2 inverted nipples, you may be able to correct the condition non-surgically, with the suction cup device mentioned above. However, surgery may be necessary.

Grade 3: Severe
This is the most severe type of inverted nipple. In this classification, the nipple is obviously inverted and remains that way even when stimulated. This is a result of extremely short milk ducts and tissues that draw the nipple inward, preventing it from being everted. The nipple may not be coaxed out by pinching the skin in the area. Because the nipple is not visible or accessible, breastfeeding tends to be impossible.

If you have grade 3, inverted nipple correction surgery is probably the most effective option. However, it is important to note that surgery may impact breastfeeding ability, making it impossible.

If you notice that your nipples don’t protrude but did before, it is possible that you may have recently developed the condition. This is not unheard of, particularly in women who are pregnant for the first time or who have experienced trauma. The Canadian Cancer Society recommends that you visit your doctor if you see sudden changes in the shape of your breasts, areolae and nipples, just to make sure everything is alright. This is because there are some types of cancer affecting the breast ducts that can lead to nipple inversion. Aside from cancer, other conditions can also contribute, such as:

Duct ectasia – a widening of a milk duct beneath the nipple accompanied by a thickening of the duct walls. The widened milk duct also fills with fluid that may be thick and sticky.

Periductal mastitis – inflammation of a breast duct beneath and around the nipple. This is similar to duct ectasia.

Tuberculosis – an infection caused by a bacterium called Mycobacterium tuberculosis (MTB). This usually starts in the lungs, then can spread to the breasts.

Fibroadenoma – solid tumours that are benign. They feel like smooth and round lumps in the breast.

Sometimes, aging, trauma and weight fluctuations may also cause inverted nipples.

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