Inverted Nipples

Nipples that point inward or lie flat against the areola are called inverted, or retracted, nipples. Inverted nipples affect women and men and are either congenital (present at birth) or acquired.

Although inverted nipples are usually harmless, they can be related to serious health conditions. If you experience a sudden inversion of one or both nipples, your healthcare provider should examine you as soon as possible.

This article discusses the symptoms, causes, and treatment for inverted nipples.

Woman doing a self-breast exam

Jelena Stanojkovic / Getty Images

Symptoms of Inverted Nipples

Inverted nipples affect 2% to 10% of women and are usually bilateral (both breasts). The main symptom of inverted nipples is how they appear. Inverted nipples point inward or are flush with the areola instead of protruding out.

Symptoms of inverted nipples are categorized in the following ways:

  • Grade 1: The nipple can be gently pulled out and easily remains protruded. The milk ducts under the nipple and areola are normal.
  • Grade 2: The nipple is more challenging to pull out than grade 1 and is inclined to retract when released. The milk ducts are mildly retracted, but surgical intervention is not usually necessary.
  • Grade 3: The nipple is difficult to pull out and retracts immediately when released. The milk ducts are replaced with severe fibrosis. Surgery is required to correct grade 3 inverted nipples.

Causes

Although nipples come in all shapes and sizes, common reasons for inverted or retracted nipples include the following:

  • Congenital: Most people with inverted nipples are born with them. Tight connective tissue or problems with the ductal system under the nipple lead to congenital nipple inversion.
  • Age: Nipples can change with age, becoming more flat or retracted.
  • Blocked milk ducts: Fluid buildup in the milk ducts can cause the breasts to become tight, pulling the nipples inward. Conditions like an abscess, duct ectasia, and mastitis can block milk ducts.
  • Breast injury or surgery: Scarred milk ducts from breast fat necrosis, breast reduction surgery, and nipple piercings can cause inverted nipples.
  • Breast cancer/Paget's disease: Cancer that affects the milk ducts or other parts of the breast can result in the sudden retraction of the nipples.

How to Treat Inverted Nipples

Treatment for inverted nipples depends on the cause of the condition. For congenital reasons, various surgical approaches are available to improve the appearance and function of the nipples.

An infection can be treated with antibiotics, and breast cancer is treated with chemotherapy, immunotherapy, and hormone therapy.

Breastfeeding can sometimes result in stretching breast tissue, improving inverted nipples.

Complications and Risk Factors

Risk factors for developing inverted nipples are family history and aging. The following are complications of having inverted nipples:

  • Functional problems: Depending on the severity, difficulty breastfeeding, decreased sensation, or physical discomfort can be consequences of inverted nipples.
  • Aesthetic concerns: Some people consider protruding nipples more attractive than flat or inverted nipples.
  • Psychological impact: Having inverted nipples causes some people to feel self-conscious, especially during sexual activity.

If you have inverted nipples and are experiencing any of the above complications, reach out to your healthcare provider for guidance.

Are There Tests to Diagnose the Cause of Inverted Nipples?

Your healthcare provider can use a variety of tests to diagnose the cause of inverted nipples. The tests may include the following:

  • Physical exam: Helps your healthcare provider determine what other tests you need
  • Mammogram: An X-ray of the breasts that helps to identify a new mass
  • Ultrasound: Uses sound waves to determine if a mass is solid or filled with fluid
  • Magnetic resonance imaging (MRI): Provides a detailed view of the breasts
  • Biopsy: Removal and testing of a sample of tissue for breast cancer and other conditions
  • Wound culture: Helps determine what bacteria is responsible for any infection when there is drainage or a wound

When to See a Healthcare Provider

Any new or sudden changes to your nipples should be immediately reported to your healthcare provider, including:

Summary

Inverted or retracted nipples point inward instead of protruding out. The most common cause of inverted nipples is being born with them, but some people may acquire inverted nipples due to aging, infection, breast injuries, or cancer.

Although usually harmless, inverted nipples can lead to functional, psychological, and aesthetic consequences. There are surgical procedures that can improve inverted nipples. If you have any new or sudden changes in the appearance of your nipples, notify your healthcare provider immediately.

Frequently Asked Questions

  • What causes inverted nipples?

    Tight milk ducts and connective tissue under the nipples usually cause inverted nipples. New or sudden nipple inversion can occur with infection, breast injury, or breast cancer.

  • Are inverted nipples harmful?

    Inverted nipples are only harmful if they occur due to infection or cancer.

  • Can inverted nipples be corrected?

    Several types of surgical procedures can correct inverted nipples. Breastfeeding can also help stretch out tight milk ducts, improving inverted nipples.

  • Can I breastfeed with inverted nipples?

    Most people with grade 1 or grade 2 inverted nipples can still breastfeed. If you have inverted nipples, work with a lactation consultant to facilitate breastfeeding.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Serenity Mirabito RN, OCN
Serenity Mirabito, MSN, RN, OCN, advocates for well-being, even in the midst of illness. She believes in arming her readers with the most current and trustworthy information leading to fully informed decision making.