An inverted nipple (occasionally invaginated nipple) is a condition where the nipple, instead of pointing outward, is retracted into the breast. In some cases, the nipple will be temporarily protruded if stimulated. Many patients are born with inverted nipples. These may get worse with advancing age. Inverted nipples may cause cosmetic concerns and can interfere with breastfeeding.

The sudden appearance of inverted nipples can be a sign of possible breast cancer. You should consult your doctor if this applies to you.

There are three degrees of severity :

  • Grade 1: These nipples are occasionally inverted, but will evert spontaneously. Surgery is not required for this group.
  • Grade 2: Nipples in this category will not evert spontaneously, but can be manually pulled out. Surgery can benefit patients in this category.
  • Grade 3: This is the most severely affected group. The nipples cannot manually be pulled out. Surgery is the only method for correction in this group.

There are many operations described for inverted nipples. One of the most conservative and effective operations is the use of nipple piercing. This can be performed under local or general anesthetic.

A 'barbell' device is passed from 3 to 9 o’ clock. This stretches the contracted nipple ducts. The piercing has to be left in continuously for 6 months. Once removed the ducts remain in their stretched state, so correcting the inverted nipples.

Mild degrees of inverted nipples can also be corrected with breast augmentation. The correction is produced by the implant pushing the breast tissue forward, effectively increasing the length of the tethered and shortened ducts.

Other techniques rely on cutting the ducts and are therefore more likely to impair breastfeeding. These techniques are used usually only after the piercing technique has failed. As the piercing technique is the least destructive to the ducts, it is also less likely to result in permanent or excessive scarring. There is also a lower incidence of sensory loss.

Furthermore, this technique is less likely to permanently damage or divide the milk ducts. It is therefore, the technique that is least likely to interfere with breastfeeding. It should be noted that even with surgery, some patients may not be able to breastfeed successfully. This is especially so, if they have the more severe grades of an inverted nipple and this may be the case with or without surgery.