Inverted Nipple Correction
What is it?
Inverted nipple is a condition in men or women where the nipple protrudes inward, rather than outward. Even with stimulation, the nipple may not protrude. The condition is actually rather common with 10 to 20% of women having at least one inverted nipple. It could be one sided (unilateral) or both sides (bilateral). There are many possible causes of inverted nipples including:
- Congenital (born with the condition)
- Breast cancer (often inflammatory)
- In men, gynecomastia could be a cause
- fat necrosis (possibly trauma related)
- Infections of the breast
- Genetic variant of nipple shape
- Scars which may be a result of surgery
- Breast ptosis (drooping of breasts)
Naturally, with any condition there is a grading system to characterize the extent of the inversion. The typical classification ranges from 1 to 3, with 3 being severely inverted and retracted. Grade is often called a “shy nipple”. It may come out with manipulation or stimulation quite easily. Class 2 has a bit more fibrosis within the tissue. It can be pulled out manually, but often retracts back and may not protrude with stimulation. Class 2 is the most common type for men and women. In class 3 nipple inversion, the nipple can rarely be pulled out physically and often requires surgery in order to be protracted. With this level of inversion, milk ducts are often constricted and breast feeding is impossible. Women with Grade 3 inverted nipples may also be affected rashes or infections because hygiene becomes difficult.
The treatment of inverted nipples ranges from massaging, to piercing, to suction, to surgery. The less invasive techniques are more successful with Class 1 nipple inversion. Thus, in mild cases, persistent nipple and areolar massaging alone can correct inversion. There are devices that are available to “suck out” the nipple. These work with varying results and can, not surprisingly, be difficult to use regularly. Another method to keep nipple protracted is nipple piercing. A pierced nipple through and through mechanically keeps the nipple out. Over time (and it could be months to years), some mild to moderate nipple inversions can be permanently corrected with this technique. However, in severely inverted conditions surgery may be the best option.
Surgical correction of the nipple is an outpatient procedure that can be performed under local anesthesia. There are 2 well described approaches. One involves making an incision along the inferior border of the areola to access the ducts below the nipples. With spreading or cutting, the ducts that are tethering down the nipple can be disrupted to free the nipple. The nipple may then be propped up with suspension stitches for a week. The second involves making a small incision along the inferior border of the nipple. From this access point the ducts tethering down the nipple can be freed. Both approaches may very likely prevent lactation making breast feeding from the nipple impossible.
After the procedure, one is discharged home with pain medications. There will be some soreness for a few days. Stitches are often removed after a week.