An inverted nipple is a condition in which the nipple points inward into the breast instead of pointing outward. This condition can also be called nipple inversion or nipple retraction. Nipple inversion can occur to varying degrees and sometimes affects only one nipple or both. Nipple reconstruction is a surgical procedure that aims to improve the appearance of breasts by increasing the size of one or both of the nipples to make them more symmetrical and normal in appearance.
An inverted nipple usually occurs when breast tissue adheres tightly to the base of the nipple, enough to prevent it from sticking out, or due to shortening of the milk ducts, which pass through the breast and extend into the top of the nipples. The most common causes of inverted nipples can be congenital, surgical, traumatic; or due to breastfeeding, breast drooping, infection, pregnancy, or breast cancer.
Around 10% or 20% of all women are born with this condition. The most common nipple variations that women are born with are caused by short ducts or a wide areola muscle sphincter.
Inverted nipples are classified within three grades:
Grade 1: It refers to nipples that can easily be pulled out by using finger pressure around the areola.
Grade 2: The inverted nipple which can be pulled out, though not as easy as the grade 1 inverted nipple but which retracts after pressure is relaxed.
Grade 3: It describes a severely inverted and retracted nipple that can rarely be pulled out physically and which requires surgery in order to be protracted. Milk ducts are often constricted, and breastfeeding is impossible in this case.
Inverted nipple surgery is usually performed under local anesthesia. The inverted nipple surgery takes between 30 minutes and 2 hours. It is usually performed as day-case surgery, meaning patients will be able to go home the same day as the procedure. There are many techniques and surgical treatments for inverted nipple correction such as the vertical bipedicled technique or two triangular dermal flaps. As a surgical procedure, the inverted nipple is corrected by cutting the channels of the milk gland that pull the nipple in. Thus, the patient’s nipple gets rid of the tissue surrounding it. A suture is secured and placed around the nipple and a small splint is applied to hold it in a protruding position. The suture and splint need to remain in place for about one week.
Nipple reconstruction surgery is one method of correcting inverted nipples and is usually very successful. It may permanently destroy the capacity to breastfeed if not performed correctly. Therefore, selecting an experienced surgeon will increase the success rate of the inverted nipple surgery. Even so, breastfeeding ability cannot be guaranteed after nipple reconstruction for inverted nipples. Therefore, the patient should clearly state whether she will consider having a baby or breastfeeding in the future. For this reason, it is recommended to correct the inverted nipple after any ongoing breastfeeding if the patient is able to obtain milk from the breast.
