Overview

An inverted nipple is a condition where the nipple appears retracted or pulled inward instead of protruding outward. It can affect one or both nipples and may be present from birth (congenital) or develop later in life (acquired). While many cases of inverted nipples are harmless and purely cosmetic, a sudden change in nipple appearance, especially in adults, can sometimes be a sign of an underlying medical issue that requires evaluation. Inverted nipples can impact breastfeeding and may occasionally cause self-esteem concerns, but a variety of treatments are available depending on the cause.

Causes

The causes of inverted nipples vary and are classified as congenital or acquired:

• Congenital causes: Some people are born with shortened milk ducts or connective tissue bands that pull the nipple inward, leading to a lifelong inversion.
• Breastfeeding-related changes: Scarring or changes in milk ducts after breastfeeding can lead to nipple inversion.
• Aging: As people age, changes in breast tissue elasticity may cause nipple inversion.
• Infections: Infections such as mastitis or abscesses can lead to inflammation and retraction of the nipple.
• Duct ectasia: A benign condition where milk ducts become swollen or blocked, causing nipple inversion, commonly seen in middle-aged or older women.
• Trauma or surgery: Previous breast surgeries or trauma can result in scar tissue pulling the nipple inward.
• Breast cancer: A new onset of nipple inversion, especially when associated with other breast changes, may be an early sign of breast cancer and should be promptly evaluated.

Symptoms

The primary symptom is the inward pulling of the nipple, which can be constant or intermittent. Other associated symptoms may include:

• Flat or sunken nipple: The nipple may appear flat, partially inverted, or completely pulled inward.
• Breast asymmetry: One nipple may be inverted while the other appears normal.
• Discharge: Some people may notice nipple discharge, especially in cases of infection or duct ectasia.
• Breast pain or tenderness: Occasionally present if inversion is caused by infection or inflammation.
• Skin changes: Redness, thickening, or dimpling of the breast skin may accompany inversion in certain conditions.

Diagnosis

Diagnosing an inverted nipple involves a thorough clinical evaluation and sometimes imaging tests to rule out underlying causes:

• Medical history: The doctor will inquire about the duration of inversion, presence of pain, discharge, and any related symptoms.
• Physical examination: Inspection and palpation of the breast and nipple to assess inversion severity and identify any underlying lumps.
• Breast ultrasound: Useful to detect abnormalities in breast tissue or milk ducts.
• Mammography: Recommended, especially in older individuals or if cancer is suspected.
• Biopsy: If any suspicious lumps or changes are found, a biopsy may be done to rule out malignancy.

Treatment

Treatment depends on the cause and severity of nipple inversion:

• No treatment (benign cases): In cases where inversion is congenital, painless, and without other symptoms, treatment may not be necessary.
• Manual techniques: Regular gentle pulling or Hoffman exercises may help in mild cases.
• Nipple shields or suction devices: Special suction devices can help evert the nipple, particularly useful for breastfeeding mothers.
• Treatment of underlying conditions: Antibiotics for infections, or addressing duct ectasia, can resolve associated inversion.
• Surgical correction: For persistent or cosmetically concerning cases, procedures like nipple eversion surgery or duct release surgery can correct inversion.
• Cancer treatment: If inversion is linked to breast cancer, appropriate oncological treatments including surgery, chemotherapy, or radiation will be recommended.

Prognosis

The outlook for inverted nipples depends on the underlying cause:

• Congenital cases: Typically harmless and stable over time, with surgical correction available if desired.
• Infection-related inversion: Often reversible with prompt treatment of the infection.
• Post-surgical cases: May be permanent depending on the extent of scarring, but surgical revision may improve appearance.
• Breast cancer-related inversion: Prognosis depends on early diagnosis and effective treatment of cancer.
• Breastfeeding outcomes: Many women with inverted nipples are still able to breastfeed with assistance, though some may face challenges.

In most cases, inverted nipples are benign and manageable. Medical evaluation is crucial for new or sudden nipple inversion to rule out serious underlying conditions.