Cosmetic Treatment for Inverted Nipples

An inverted nipple is a condition in which the nipple does not project out from the breast, but instead is retracted. This condition can happen in either one or both breasts and is more common in women than in men. There is a simple cosmetic surgical procedure to correct inverted nipples, which can be performed on an outpatient basis right in our office at Jefferson Plastic Surgery.

What Causes Inverted Nipples?

The most common cause for inverted nipples is hereditary. Approximately 10 to 20 percent of female infants are born with inverted nipples. Other causes include direct trauma to the nipple, breastfeeding, dramatic weight loss, pregnancy, breast cancer, or sagging breasts. Gynecomastia (enlarged breasts in men) may also cause inverted nipples.

There are three grades for inverted nipples, depending upon the severity of the condition:

• Grade 1: The nipple can be easily pushed out with gentle pressure around the areola (the area of darkened skin around the nipple) and may stay out for a while after pressure is released. This condition is sometimes referred to as “shy nipples.” Because the milk ducts and glands are not affected, it is possible to breastfeed with grade 1 nipple inversion.
• Grade 2: The nipple can be made to protrude, but will retract almost immediately once pressure on the areola is released. Breastfeeding is more difficult than with Grade 1 inverted nipples, but is not necessarily impossible.
• Grade 3: The nipple cannot protrude with areola pressure or stimulation. The milk ducts are constricted, and breastfeeding is not possible. Patients with Grade 3 inverted nipples may develop nipple infections or rashes, or have difficulty maintaining proper nipple hygiene. These patients will require surgery to correct the nipples.

Surgical Technique for Inverted Nipples

There are two techniques that are used to surgically address inverted nipples, depending upon whether or not the patient wishes to have the capacity to breastfeed after surgery. If the milk ducts and glands will be spared, our surgeons will make small incisions to stretch out the glands and ducts, thereby releasing the nipple, but without actually severing the mammary structures. The nipple and areola structures will then be lifted up, and sutured into a protruding state using circular purse-string stitches that actually draw the sides of the nipple together until the nipple sticks out. If the mammary structures cannot be saved, they will be completely severed from the nipple and areola structure before the nipple is moved into the protruded position and sutured in place.

Once the procedure is done, small shields will be applied to the nipples to hold them in the new protruded position, and medicated gauze is applied to reduce the chance of infection and protect the healing nipples from chafing against clothing or bras.

Inverted nipples can be a source of self-consciousness, and can also lead to problems with breastfeeding and proper hygiene. Fortunately, there is a surgical procedure that can correct the problem with a minimal amount of discomfort and recovery time.