Inverted nipple
Encyclopedia
An inverted 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, but in others, the inversion remains regardless of stimulus. Women and men can have inverted nipples.
. Most women with inverted nipples who give birth are able to breastfeed without complication, but inexperienced mothers may experience higher than average pain and soreness when initially attempting to nurse. When a mother uses proper breastfeeding technique, the infant latches onto the areola
, not the nipple, so women with inverted nipples are actually able to breastfeed without issue. An infant
that latches on well may be able to slush out an inverted nipple. The use of a breast pump
or other suction device immediately before a feeding may help to draw out inverted nipples. A hospital grade electric pump may be used for this purpose. Some women also find that using a nipple shield
can help facilitate breastfeeding. Frequent stimulation such as sexual intercourse and foreplay (such as nipple sucking) also helps the nipple protract.
Plastic surgery
is one method of protracting inverted nipples. If a woman elects to have this surgery performed on her inverted nipples, it can permanently destroy her capacity to breastfeed. Another method of protracting inverted nipples is to have the nipple pierced
. This method will only be effective if the nipple can be temporarily protracted. If pierced when protracted, the jewelry may prevent the nipple from returning to its inverted state. The success of both of these methods, from a cosmetic standpoint, is mixed.
Other strategies for protracting inverted nipples include regularly stimulating the nipples to a protruding state, in an attempt to gradually loosen the nipple tissue. Some sex toy
s designed for nipple stimulation, such as suction cups or clamps
may also cause inverted nipples to protract or stay protracted longer. There are special devices specifically designed to draw out inverted nipples or a homemade nipple protractor can be constructed out of a 10 cc disposable syringe
. These methods are often used in preparation for breast-feeding, which can sometimes cause inverted nipples to become protracted permanently.
Two methods which are now discouraged are breast shell
s and the Hoffman technique. Breast shells may be used to apply gentle constant pressure to the areola
in order to try and break any adhesions under the skin that are preventing the nipple from being drawn out. The shells are worn inside the bra
. The Hoffman technique is a nipple stretching exercise that may help loosen the adhesions at the base of the nipple when performed several times a day. Although both techniques are heavily promoted, a 1992 study found that not only do shells and the Hoffman technique not promote more successful breastfeeding, they may actually disrupt it.
Around 10-20% of all women are born with this condition. Most common nipple variations that women are born with are caused by short ducts or a wide areola muscle sphincter
.
Inverted nipples can also occur after sudden and major weight loss.
existent in the breast as well as the damage it has caused on the milk ducts.
Inverted nipple Grade 1 refers to nipples that can easily be pulled out, by using finger pressure around the aureola. The Grade 1 inverted nipple maintains its projections and rarely retracts. Also, Grade 1 inverted nipples may occasionally pop up without manipulation or pressure. Milk ducts are usually not compromised and breast feeding is possible. These are "shy nipples". It is believed to have minimal or no fibrosis. There is no soft-tissue deficiency of the nipple. The lactiferous duct should be normal without any retraction.
Inverted nipple Grade 2 is the nipple which can be pulled out, though not as easily as the grade 1 inverted nipple but which retracts after pressure is released. Breast feeding could be possible even though it is more likely to be either very difficult or impossible. Grade 2 nipples have a moderate degree of fibrosis. The lactiferous ducts are mildly retracted but do not need to be cut for the release of fibrosis. On histological examination, these nipples have rich collagenous stromata with numerous bundles of smooth muscle. Most women with this problem suffer from inverted nipples Grade 2.
Inverted nipple Grade 3 describes a severely inverted and retracted nipple which can rarely be pulled out physically and which requires surgery in order to be protracted. Milk ducts are often constricted and breast feeding is impossible. Women with Grade 3 inverted nipples may also struggle with infections, rashes, or problems with nipple hygiene. The fibrosis is remarkable and lactiferous ducts are short and severely retracted. The bulk of soft tissue is markedly insufficient in the nipple. Histologically, there are atrophic terminal duct lobular units and severe fibrosis.
Although surgery is normally performed as outpatient procedures and patients are able to go home after few hours following the surgery, some women may be asked to remain in the hospital overnight. However, the patients are not advised to be driving after the procedure because they will be still under the effect of anesthesia
and therefore it is best to be driven home by a friend or relative. The main side effects of surgery are pain, swelling and sensitivity in the nipple area which can last for up to two weeks after the procedure has been performed.
Recovery time is however different with each patient. Patients are encouraged to move around immediately after surgery and after they get home they are recommended to stay in bed for 2 days following the procedure. Patients can generally go back to work in a week after the surgery.
Immediately after the procedure the nipples will more likely feel sore. The soreness should diminish however within few days. Most of the time, patients are prescribed pain killers to help them cope with the discomfort.
Medicated gauze
is used following the surgical procedure to cover the nipples. They have the aim to protect the small stitched incisions on the nipple. Patients may feel a little groggy as a side effect of the surgery, but this feeling is expected to subside within a day or so. Patients are recommended not to shower the same day when the surgery was performed, but the next day.
Patients normally experience mild to moderate swelling which peaks two or three days after the procedure, and then disappears rapidly over the following three weeks. Bruising is rare. The sutures are removed four days after the procedure.
Risks that are carried by this type of surgery include infection
, unsatisfactory results, excessive bleeding, adverse reaction to anesthesia, and the need for second or sometimes third procedures. The ability to breastfeed cannot be guaranteed after any surgery to correct inverted nipples. Therefore, the patient should clearly specify if she takes into consideration having babies in the future and breastfeeding them.
Nipple
In its most general form, a nipple is a structure from which a fluid emanates. More specifically, it is the projection on the breasts or udder of a mammal by which breast milk is delivered to a mother's young. In this sense, it is often called a teat, especially when referring to non-humans, and...
, instead of pointing outward, is retracted into the breast
Breast
The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants.Both men and women develop breasts from the same embryological tissues...
. In some cases, the nipple will be temporarily protruded if stimulated, but in others, the inversion remains regardless of stimulus. Women and men can have inverted nipples.
Pregnancy and breastfeeding
Individuals with inverted nipples may find that their nipples protract (come out) temporarily or permanently during pregnancy, or as a result of breastfeedingBreastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...
. Most women with inverted nipples who give birth are able to breastfeed without complication, but inexperienced mothers may experience higher than average pain and soreness when initially attempting to nurse. When a mother uses proper breastfeeding technique, the infant latches onto the areola
Areola
This article is about the breast tissue. For the entomology term, see the glossary of Lepidopteran terms. For an artistic cloud motif, see aureola. For the cactus feature, see Areole....
, not the nipple, so women with inverted nipples are actually able to breastfeed without issue. An infant
Infant
A newborn or baby is the very young offspring of a human or other mammal. A newborn is an infant who is within hours, days, or up to a few weeks from birth. In medical contexts, newborn or neonate refers to an infant in the first 28 days after birth...
that latches on well may be able to slush out an inverted nipple. The use of a breast pump
Breast pump
A breast pump is a mechanical device that extracts milk from the breasts of a lactating woman. Breast pumps may be manual devices powered by hand or foot movements or electrical devices powered by mains electricity or batteries.- History :...
or other suction device immediately before a feeding may help to draw out inverted nipples. A hospital grade electric pump may be used for this purpose. Some women also find that using a nipple shield
Nipple shield (breastfeeding)
A nipple shield is a nipple-shaped sheath worn over the areola and nipple during breastfeeding. Modern nipple shields are made of soft, thin, flexible silicone and have holes at the end of the nipple section to allow the breast milk to pass through. Older nipple shields were made of latex and...
can help facilitate breastfeeding. Frequent stimulation such as sexual intercourse and foreplay (such as nipple sucking) also helps the nipple protract.
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...
is one method of protracting inverted nipples. If a woman elects to have this surgery performed on her inverted nipples, it can permanently destroy her capacity to breastfeed. Another method of protracting inverted nipples is to have the nipple pierced
Body piercing
Body piercing, a form of body modification, is the practice of puncturing or cutting a part of the human body, creating an opening in which jewelry may be worn. The word piercing can refer to the act or practice of body piercing, or to an opening in the body created by this act or practice...
. This method will only be effective if the nipple can be temporarily protracted. If pierced when protracted, the jewelry may prevent the nipple from returning to its inverted state. The success of both of these methods, from a cosmetic standpoint, is mixed.
Other strategies for protracting inverted nipples include regularly stimulating the nipples to a protruding state, in an attempt to gradually loosen the nipple tissue. Some sex toy
Sex toy
A sex toy is an object or device that is primarily used to facilitate human sexual pleasure. The most popular sex toys are designed to resemble human genitals and may be vibrating or non-vibrating...
s designed for nipple stimulation, such as suction cups or clamps
Nipple clamp
A nipple clamp is a clamp that can be applied to the nipples of either men or women. It is a sex toy which can be attached to the nipples to create pain by restricting blood flow from erect nipples by applying pressure to them. Some people derive erotic pleasure from seeing nipple clamps applied....
may also cause inverted nipples to protract or stay protracted longer. There are special devices specifically designed to draw out inverted nipples or a homemade nipple protractor can be constructed out of a 10 cc disposable syringe
Syringe
A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...
. These methods are often used in preparation for breast-feeding, which can sometimes cause inverted nipples to become protracted permanently.
Two methods which are now discouraged are breast shell
Breast shell
Breast shells are hollow plastic disks worn inside the brassiere to protect the nipple from becoming flattened. The disk has a hole in the middle worn toward the nipple side. It is slightly concave to conform to the shape of the breast, but can sometimes still be slightly visible under tight...
s and the Hoffman technique. Breast shells may be used to apply gentle constant pressure to the areola
Areola
This article is about the breast tissue. For the entomology term, see the glossary of Lepidopteran terms. For an artistic cloud motif, see aureola. For the cactus feature, see Areole....
in order to try and break any adhesions under the skin that are preventing the nipple from being drawn out. The shells are worn inside the bra
Brassiere
A brassiere is an undergarment that covers, supports, and elevates the breasts. Since the late 19th century, it has replaced the corset as the most widely accepted method for supporting breasts....
. The Hoffman technique is a nipple stretching exercise that may help loosen the adhesions at the base of the nipple when performed several times a day. Although both techniques are heavily promoted, a 1992 study found that not only do shells and the Hoffman technique not promote more successful breastfeeding, they may actually disrupt it.
Causes
The most common causes of nipple inversion include:- Born with condition
- Breastfeeding
- Trauma which can be caused by conditions such as fat necrosisNecrosisNecrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...
, scars or it may be a result of surgery - Breast Sagging, Drooping or PtosisPtosis (breasts)Ptosis of the breast refers to drooping or sagging of the breast. Breast ptosis is related to the laxity of the superficial fascia, suspensory ligaments and skin....
- Breast cancer including breast carcinomaCarcinomaCarcinoma is the medical term for the most common type of cancer occurring in humans. Put simply, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that generally arises from cells originating in the endodermal or ectodermal germ layer during...
, Paget's diseasePaget's disease of the breastPaget's disease of the breast is a malignant condition that outwardly may have the appearance of eczema, with skin changes involving the nipple of the breast....
and Inflammatory Breast CancerInflammatory breast cancerInflammatory breast cancer is an especially aggressive type of breast cancer that can occur in women of any age .It is called inflammatory because it frequently presents with symptoms resembling an inflammation...
(IBC) - Breast infections or inflammations such as mammary duct ectasia, breast abscess or mastitisMastitisMastitis is the inflammation of breast tissue. S. aureus is the most common etiological organism responsible, but S. epidermidis and streptococci are occasionally isolated as well.-Terminology:...
- Genetic variant of nipple shape such as Weaver syndromeWeaver syndromeWeaver syndrome is a congenital disorder associated with rapid growth beginning in the prenatal period, a characteristic facial appearance and certain skeletal features. It was first described by Weaver in 1974....
, Fryns- Aftimos syndrome, Chromosome 2q Deletion or congenital disorder of glycosylationGlycosylationGlycosylation is the reaction in which a carbohydrate, i.e. a glycosyl donor, is attached to a hydroxyl or other functional group of another molecule . In biology glycosylation refers to the enzymatic process that attaches glycans to proteins, lipids, or other organic molecules...
type 1A & 1 L or Kennerknecht-Sorgo-Oberhoffer syndrome - GynecomastiaGynecomastiaGynecomastia or Gynaecomastia, , is the abnormal development of large mammary glands in males resulting in breast enlargement. The term comes from the Greek γυνή gyné meaning "woman" and μαστός mastós meaning "breast"...
- HoloprosencephalyHoloprosencephalyHoloprosencephaly is a cephalic disorder in which the prosencephalon fails to develop into two hemispheres. Normally, the forebrain is formed and the face begins to develop in the fifth and sixth weeks of human pregnancy...
, recurrent infections, and monocytosisMonocytosisMonocytosis is an increase in the number of monocytes circulating in the blood. Monocytes are white blood cells that give rise to macrophages and dendritic cells in the immune system.... - Pregnancy
- TuberculosisTuberculosisTuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
Around 10-20% of all women are born with this condition. Most common nipple variations that women are born with are caused by short ducts or a wide areola muscle sphincter
Sphincter
A sphincter is an anatomical structure, or a circular muscle, that normally maintains constriction of a natural body passage or orifice and which relaxes as required by normal physiological functioning...
.
Inverted nipples can also occur after sudden and major weight loss.
Grading system
There are three grades of inverted nipples, defined on how easily the nipple may be protracted and the degree of fibrosisFibrosis
Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. This is as opposed to formation of fibrous tissue as a normal constituent of an organ or tissue...
existent in the breast as well as the damage it has caused on the milk ducts.
Inverted nipple Grade 1 refers to nipples that can easily be pulled out, by using finger pressure around the aureola. The Grade 1 inverted nipple maintains its projections and rarely retracts. Also, Grade 1 inverted nipples may occasionally pop up without manipulation or pressure. Milk ducts are usually not compromised and breast feeding is possible. These are "shy nipples". It is believed to have minimal or no fibrosis. There is no soft-tissue deficiency of the nipple. The lactiferous duct should be normal without any retraction.
Inverted nipple Grade 2 is the nipple which can be pulled out, though not as easily as the grade 1 inverted nipple but which retracts after pressure is released. Breast feeding could be possible even though it is more likely to be either very difficult or impossible. Grade 2 nipples have a moderate degree of fibrosis. The lactiferous ducts are mildly retracted but do not need to be cut for the release of fibrosis. On histological examination, these nipples have rich collagenous stromata with numerous bundles of smooth muscle. Most women with this problem suffer from inverted nipples Grade 2.
Inverted nipple Grade 3 describes a severely inverted and retracted nipple which can rarely be pulled out physically and which requires surgery in order to be protracted. Milk ducts are often constricted and breast feeding is impossible. Women with Grade 3 inverted nipples may also struggle with infections, rashes, or problems with nipple hygiene. The fibrosis is remarkable and lactiferous ducts are short and severely retracted. The bulk of soft tissue is markedly insufficient in the nipple. Histologically, there are atrophic terminal duct lobular units and severe fibrosis.
Modification options
Correction of inverted nipples may be done in several ways depending on the degree of retraction. However, recovery is specific to each procedure.Although surgery is normally performed as outpatient procedures and patients are able to go home after few hours following the surgery, some women may be asked to remain in the hospital overnight. However, the patients are not advised to be driving after the procedure because they will be still under the effect of anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
and therefore it is best to be driven home by a friend or relative. The main side effects of surgery are pain, swelling and sensitivity in the nipple area which can last for up to two weeks after the procedure has been performed.
Recovery time is however different with each patient. Patients are encouraged to move around immediately after surgery and after they get home they are recommended to stay in bed for 2 days following the procedure. Patients can generally go back to work in a week after the surgery.
Immediately after the procedure the nipples will more likely feel sore. The soreness should diminish however within few days. Most of the time, patients are prescribed pain killers to help them cope with the discomfort.
Medicated gauze
Gauze
Gauze is a thin, translucent fabric with a loose open weave.-Uses and types:Gauze was originally made of silk and was used for clothing. It is now used for many different things, including gauze sponges for medical purposes. When used as a medical dressing, gauze is generally made of cotton...
is used following the surgical procedure to cover the nipples. They have the aim to protect the small stitched incisions on the nipple. Patients may feel a little groggy as a side effect of the surgery, but this feeling is expected to subside within a day or so. Patients are recommended not to shower the same day when the surgery was performed, but the next day.
Patients normally experience mild to moderate swelling which peaks two or three days after the procedure, and then disappears rapidly over the following three weeks. Bruising is rare. The sutures are removed four days after the procedure.
Risks that are carried by this type of surgery include infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
, unsatisfactory results, excessive bleeding, adverse reaction to anesthesia, and the need for second or sometimes third procedures. The ability to breastfeed cannot be guaranteed after any surgery to correct inverted nipples. Therefore, the patient should clearly specify if she takes into consideration having babies in the future and breastfeeding them.