What Causes Inverted Nipples?

Inverted nipples are usually harmless, however, they can make breastfeeding more difficult and, in some cases, could be a sign of infection or cancer. Here are some of the most common causes of inverted nipples:

• Breastfeeding: Scar tissue can accumulate in the milk ducts during breastfeeding, causing the ducts to exert more force on the nipple, pulling it inward.
• Aging: The milk ducts naturally shorten and widen with age, which can cause the nipples to invert.
• Prior Breast Surgeries: Breast surgeries, particularly ones that involve incisions around the nipple and underlying milk duct tissue, can inflame the ducts and pull the nipple internally.
• Infection: Mastitis and mammary duct clogs or infections may also cause inverted nipples. These infections are more common in women who are breastfeeding or who are peri-menopausal or post-menopausal.
• Cancer: Tumors underneath the nipple can cause it to invert, as well as Paget’s disease, a form of cancer that can form in the nipple.
• Genetics: Everybody’s anatomy is unique and some people are simply born with inverted nipples.

Levels of Nipple Inversion

Nipples are erectile tissue that usually responds to touch or temperature changes, but sometimes inverted nipples can’t evert at all in response to pulling or stimulation. Nipple inversions are graded based on severity, and there are three stages:

Level 1: The inverted nipple responds to stimulation, such as touch and temperature changes, and usually projects outwards but is sometimes inverted. Patients with level 1 nipple inversion can usually breastfeed.

Level 2: The inverted nipple is inverted most of the time, but can evert in response to stimulation for a very short period. Patients with level 2 nipple inversion may be able to breastfeed.

Level 3: The inverted nipple is inverted all of the time, and does not project as a result of pulling or stimulation. Patients with level 3 nipple inversion are unlikely to be able to breastfeed.

Inverted Nipple Correction: What to Expect

Some non-surgical options may help stretch out the milk ducts and evert level 1 or level 2 inverted nipples. For example, suction cup devices may help gently stretch the milk ducts and release tension exerted on the nipple, causing it to project in a more natural position. If non-surgical treatments don’t work, then inverted nipple correction surgery offers a quick and effective solution.

Before your nipple surgery, we will bring you in for a consultation to discuss your medical history and surgical goals. If you plan on getting pregnant and breastfeeding, that will influence our treatment options and we may recommend delaying the operation. We’ll also examine your anatomy and discuss the procedure, potential risks, recovery, and anticipated results.

Performed in the office under a local anesthetic, inverted nipple corrections take around 30 minutes, and many patients recover very quickly. During the procedure, we’ll make a small incision at the base of your nipple. Through this incision we will divide the milk ducts, separating that tissue from the nipple. Next, we’ll place an interior suture to stabilize the nipple position and will close the incision with a single stitch. By dividing the ducts, we prevent re-inversion, however, it’s not possible to breastfeed after this approach. Another option is to stretch the ducts instead of separating them, which can maintain breastfeeding function but is less effective and can result in re-inversion.

Our nipple correction patients usually feel ready to return to work and everyday activities one to two days after the procedure, but everyone heals at their own pace. Listen to your body and avoid high-intensity exercise for one week. Some swelling and changes in your nipple sensation are to be expected. You’ll be able to drive yourself home after your procedure. We perform inverted nipple corrections as outpatient procedures at our accredited Northern Arizona SurgiCenter in Flagstaff.

Medical Review: This procedural information has been medically reviewed by plastic and reconstructive surgeon, Brian A. Cripe, M.D.