What Are Inverted Nipples?

Understanding breast health includes awareness of issues with your nipples, like nipple discharge. When it comes to appearance, nipples can look all sorts of ways—light, dark, big, small, flat, or protruding. If yours point in or lie flat, you have what is referred to as inverted nipples.

An estimated 10 to 20% of people—of all genders—have inverted nipples. They can affect one nipple or both but are common and usually harmless. Read on to learn more about this condition.

What Causes Inverted Nipples?

When milk ducts don't develop and grow as breast tissue is growing, inverted nipples can be the result. A person might also have inverted nipples because of fibrosis—when fibrous connective tissue grows around the ducts because of inflammation.

Inverted nipples can be considered congenital or acquired. If inverted nipples are congenital, a person was born with them. Inverted nipples acquired are ones where a person developed them, sometimes due to another underlying condition.

How Are Inverted Nipples Diagnosed?

A diagnosis of inverted nipples usually happens during a wellness physical for younger individuals before puberty or a physical examination. If inverted nipples persist beyond puberty and are accompanied by discharge, malignancy, or duct dilation, more diagnostic tests may be necessary.

Healthcare providers may use mammography, ultrasound, or ductoscopy—a minimally-invasive procedure where a provider uses a micro-endoscope to examine the milk ducts.

These other tests will help providers learn more information about what might be causing inverted nipples. They may also ask about personal and family history concerning malignant tissues of the breast as well as breast trauma history.

Treatments for Inverted Nipples

The main goals for treating inverted nipples are to:

• Recover lasting shape and projection of inverted nipples
• Maintain normal nipple sensitivity
• Preserve milk ducts along with minimal scarring

There are two main categories of treatment: duct preserving treatment and duct damaging treatment.

Duct preserving treatment options can keep the milk ducts intact and might be invasive or non-invasive. They include methods such as suction devices or procedures without fibrosis removal. Duct damaging treatment includes techniques that prevent milk ducts from staying intact and is only invasive.

There is no standardized method for treating inverted nipples. Depending on the grade of the nipple, inverted nipple treatment will vary. Grade 1 and grade 2 inverted nipples may benefit from invasive or non-invasive procedures, while grade 3 inverted nipples usually require invasive procedures.

Breastfeeding With Inverted Nipples

Inverted nipples can cause issues with breastfeeding and affect how a person feels about being able to do so. For example, inverted nipples can lead to:

• Inadequate latching from the baby
• A low amount of milk being extracted from the breast
• Frustrated mothers
• Stopping the process of breastfeeding early

However, with assistance, you can likely breastfeed or chest feed with inverted nipples if they are grade 1 or grade 2. It can be helpful to talk with a healthcare provider to determine if you can use a device to assist with breastfeeding. The device could provide gentle suction for inverted or flattened nipples or pull them out gently.

Comorbid Conditions

Some conditions may show up along with inverted nipples. The condition may be accompanied by:

• Erosion—the loss of outer skin
• Inflammation
• Erythema, or reddened skin
• Eczema
• Bloody nipple discharge
• Palpable subareolar mass—a growth of cells that can be felt under a person's areola

Conditions Healthcare Providers Want To Rule Out

A nipple that changes like this over time may be normal. Still, it can also be a red flag for certain breast diseases, such as Paget's disease of the breast, a rare type of cancer involving the nipple and the areola—the darkened circle surrounding the nipple.

Also, congenital inverted nipples usually aren't a health concern, but acquired inverted nipples may be.

If inverted nipples are acquired, it may be due to breastfeeding or previous breast surgery. However, a healthcare provider may also want to rule out other health conditions. These could be conditions such as mammary carcinoma—where parts of breast tissue have abnormal cells—or periductal mastitis, a blockage of breast ducts.

If you notice you have inverted nipples and didn't have them previously or are concerned, talk with a healthcare provider.

A Quick Review

Inverted nipples are nipples that are flattened or don't protrude, and they are common among all people. Individuals can be born with inverted nipples or develop them later.

Healthcare providers may use different tests to diagnose the cause of inverted nipples, which can indicate other health conditions. The condition is treatable based on the grade of the nipples, and the prognosis can be good with lower-grade inverted nipples.