Correcting inverted nipples

Breast

Inverted nipples are a common malformation of the breast, but there is a surprisingly simple technique to correct this condition.

Most women have naturally protruding nipples but for many one or both nipples are inverted. This occurs when nipples retract into the breast rather than pointing out and is a condition that affects a considerable number of Australian women. It usually develops during puberty and is caused by short milk ducts, which tether the nipple and prevent it projecting.

Sometimes nipple inversion is a temporary condition and corrects itself, however in other cases the condition is permanent and many people seek help from a plastic surgeon to correct it. Although nipple inversion can occur in both men and women, it is more common among women.

Female patients are also far more likely to seek help to correct the condition, since they often have fears that nipple inversion may affect their ability to breastfeed. However, most experts agree that the majority of female patients with inverted nipples can still breastfeed, although the process may be more difficult. In fact, breastfeeding can often protract inverted nipples.

Nipple correction

Breastfeeding can be extremely difficult in women with severe nipple inversion, where the nipple is so retracted that it sits alongside the areola, or even below it. Severe cases will usually require treatment to correct the condition prior to pregnancy. Patients suffering from nipple inversion in mild and moderate forms may also desire treatment, which is usually performed by a plastic surgeon.

Previously, there was generally only one method used by plastic surgeons to correct inverted nipples: the surgical technique. The surgical method for inverted nipple repair involves making a transverse incision across the areola and through the nipple, resulting in the division of all the milk ducts. With this condition, the milk ducts are abnormally short milk, and the division of the ducts appears to fix inverted nipples surgically.

However over the past two years, many surgeons have stopped using this surgical method to fix inverted nipples. Instead they have adopted a more novel technique: piercing the nipple to encourage protraction.

Nipple piercing may not sound like a technique that is employed by plastic surgeons, but an increasing number are using the procedure to treat inverted nipples. The technique is a modification of the method used when piercing the nipple for aesthetic purposes. The nipple is pierced and a special nipple shield is used, which is a washer that covers the areola and holds the piercing out and above the level of the skin. This produces progressive stretching and protraction of the nipple.

The advantages of using nipple piercing over the traditional surgical method are numerous: there is no numbness or interference of nipple sensation, which can often result from surgery; as it only divides a small proportion of the milk ducts most young women will be able to breastfeed; and it doesn’t leave significant scars.

Then there are the aesthetic aspects. The majority of patients like their nipple jewellery so much that they decide to keep it, even after the treatment is complete and the condition has been corrected.

Patients are advised to keep the piercing and shield in for at least three to four months. It is also advisable to continue using the piercing after this time, so that they have the option of putting the shield back on if they notice any recurrence of the condition.

Another advantage is that nipple piercing is a minimally traumatic procedure for the majority of patients. It is often performed as day surgery under local anaesthetic and is usually very tolerable for most patients with inverted nipples, although those with severely inverted nipples may experience some discomfort.

This combination of factors – the minimisation of trauma and scarring, the procedure’s effectiveness and the fact that no surgery is involved – has led to nipple piercing becoming the preferred technique for an increasing number of Australian surgeons who treat inverted nipples. The fact that patients receive a fashionable piercing that many end up keeping is also favourable to many patients.

Identifying inverted nipples

There are different types of nipples and different degrees of inversion.

Dimpled nipples occur when part of the nipple protrudes. The nipple can be pulled out but doesn’t stay out.

Unilateral nipples occur when only one of the patient’s breasts has an inverted nipple.

Inverted nipples occur when the nipple is retracted into the breast. There are three different degrees of inversion: mild or slight, moderate and severe. A visual inspection is often not sufficient to decide whether a patient has inverted or flat nipples: a pinch test is required. The patient should gentle compress the areola an inch behind the nipple. If the nipple does not become erect, it is considered to be flat. If it retracts behind the areola, it is classified as inverted.

True inverted and flat nipples do not become erect when stimulated or when the patient is in cold conditions.