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Correction of Inverted Nipples

Some women have inverted nipples, with the nipple itself retracted into the areola and breast. This is a cosmetic problem, but can pose some problems for women who plan to breastfeed their babies. The condition is associated with shortened milk ducts, as well as the fibrous connective tissue between the ducts. Another issue could be that the woman lacks enough supporting tissue under the nipple. The issue of inverted nipples is very common, and the condition will typically will be evaluated as one of three levels.

An inverted nipple is retracted into the areola and breast. Inverted nipples are a cosmetic problem that doesn’t represent any health risk, but in some cases it may cause difficulty in breastfeeding.

The cause of inverted nipples is typically a combination of shortening of the milk ducts and the fibrous connective tissue between the milk ducts. In addition there can be a deficiency of supporting soft tissue underneath the nipple.

  • Grade 1 Nipple Inversion: In grade I, the inverted nipple can be pulled out and stays everted without traction for a long time. There is minimal fibrosis and no soft tissue deficiency. This can usually be treated by a suction type device or even short-term nipple piercing. If these non-surgical methods fail, a simple surgical procedure that places a purse-string suture around the base of the nipple can solve the problem. No ducts are divided.
  • Grade II Nipple Inversion: In grade II, the nipple can be everted but not as easily and tends to retract. There is some fibrosis, the ducts are shortened but usually do not need to be divided for correction. Surgery is usually required. The fibrous tethering tissue is divided but the milk ducts are preserved.
  • Grade III Nipple Inversion: Grade III is the most severe, because the nipple usually cannot be everted. If it is possible to evert, the nipple will immediately retract and surgery is required. There is a high degree of fibrosis and the milk ducts are very short and retracted. In addition there is usually a deficiency of soft tissue underneath the nipple. Correction requires surgery to divide all the tethering tissue including the milk ducts. Local flaps are also used to provide a bulk of soft tissue under the nipple. Although this will typically solve the problem, the patient will not be able to breast feed and may lose nipple sensation.

All surgeries for this condition are usually performed under local anesthesia.