When to Be Concerned About Inverted Nipples

Are you one of the 10 percent to 20 percent of women who have at least one inverted or "retracted" nipple?

If inverted nipples are something you worry about, you should know that, sometimes, it is entirely normal—especially if you were born with inverted nipples and they have never changed. However, if your nipples change and become inverted, your body might be trying to tell you something is wrong.

"Inverted nipples are usually congenital, meaning that people are born with a nipple that is pulled inward toward the breast," explained Constance M. Chen, M.D., a board-certified plastic surgeon and breast reconstruction specialist in New York. "When the inverted nipple(s) are congenital, it is usually because the milk ducts are not fully developed or the nipple base stayed small while developing in the womb."

'Inverted nipples are usually congenital, meaning that people are born with a nipple that is pulled inward toward the breast.'

However, there can be other causes, too, stated Norman Rowe, M.D., an aesthetic and reconstructive plastic surgeon at Rowe Plastic Surgery. Causes may include trauma or injury to the breast, breastfeeding, breast infection (mastitis), surgery and breast cancer.

While some people may have just one inverted nipple, Rowe stated that "most cases are bilateral—or affect both nipples."

When should you worry about inverted nipples?

Any change to your nipples is worth getting checked out by a doctor.

"If the inverted nipple happens suddenly to an adult woman who never had inverted nipples before, then she needs to see a doctor to make sure any change in the breast is not due to cancer," Chen said.

Chen advised that worrisome symptoms to look out for include bloody or other discharge, dimpling, skin changes, pain and the skin becoming hot or warm to the touch.

"If there is warmth and pain, infection or inflammation may also be the culprit," she explained. "Regardless, any sudden change should be investigated to rule out cancer."

Is it ever a sign of an underlying illness?

Just to stress, if your nipples have always been inverted, and have not changed, then there is usually nothing to worry about.

If you are pregnant or breastfeeding, inverted nipples may happen due to a clogged milk duct or an infection such as mastitis. "If there is tenderness, redness, discharge, and a lump in a breastfeeding woman, it may be an infection," Chen said. However, it's important to note you can get a clogged milk duct even if you're not breastfeeding.

Otherwise, three specific illnesses can cause inverted nipples:

1. Breast cancer
2. Tuberculosis (TB)
3. Paget's disease

"TB only causes inverted nipples in extremely rare situations," Rowe said.

"If there is a lump, dimpling, discharge, and/or skin flaking, it could be breast cancer or Paget's disease," Chen stated. "Paget's disease is a rare type of cancer of the nipple and areola (the colored circle around the nipple), which is often painful."

What treatment options are available to correct inverted nipples?

You can have cosmetic surgery for congenital inverted nipples if you choose to.

"Treatments for inverted nipples are essentially cosmetic and not too invasive," Rowe said. "Filler can be injected into the nipples to increase their projection. Also, we can pierce the nipple in a stretched position to stretch the ducts of the inverted nipples. If all else fails, surgical correction is an option as well."

"For many women with congenital inverted nipples, simply pushing or pulling out the nipple can be very helpful," Chen explained. "Some people also try a suction cup technique with an empty syringe or a hard plastic breast shell to put pressure around the nipple to try to force it outward.

"Just be aware," Chen continued, "surgery to correct inverted nipples can sometimes damage the milk ducts."

Every surgical procedure has a risk of complications—for inverted nipple surgery, they include:

• The nipple becoming inverted again after surgery
• Damage to the milk ducts
• Asymmetric nipples
• Scarring
• Pain
• Infection

Is correction even necessary?

If you have congenital inverted nipples and are perfectly happy with them, then treatment isn't necessary.

"Correction is not necessary for aesthetic reasons," Chen stated. "It is a purely cosmetic and personal choice. It's good to be aware, though, that sometimes, people with very congenitally inverted nipples may have difficulty breastfeeding."

If the nipple inversion has appeared due to breastfeeding, a blocked milk duct or mastitis, then it is likely the nipple will pop back to normal once you have treated the problem. It might take some time, though, so patience is key.

"However, if your nipples are inverted because you have breast cancer, Paget's disease, or an infection, then the disease should be treated as soon as possible," Chen advised.