While most women visit a plastic surgeon for enlarging or reducing the size of the breasts, many women visit due to inverted nipples. The condition is painless, but it can make the breasts look distorted, and if only one breast is involved, it can cause the breasts to look asymmetrical.
Patients with inverted nipples often feel embarrassed about the appearance of their breasts, particularly during sexual encounters.
Inverted nipples are due to milk ducts that are too short to allow for the nipple to protrude out, thus tethering the nipple. This leads to the nipple being ‘pulled in’ instead of protruding. While most inverted nipples are the result of short milk ducts, they can also develop after pregnancy, when post-pregnancy loss of breast tissue results in the nipple being pulled in.
Inverted Nipple Grading
Inverted nipples are categorized into three grades. The grading of inverted nipples is based on various factors associated with the condition.
- The ease of protracting (pulling out) easily the nipple
- The degree of fibrosis existing in the breast
- The damage the condition has caused on the milk ducts.
Grade 1 Inverted Nipple
Grade 1 inverted nipples can be easily be pulled out by gently applying finger pressure around the areola. Occasionally, Grade 1 inverted nipples may pop up without manipulation or finger pressure. They are often referred to as ‘shy nipples’.
In this grade, milk ducts are usually intact and hence breast feeding is possible. The affected breasts have minimal or no fibrosis at all. There is no soft-tissue deficiency and the lactiferous ducts are undamaged not pulled inward.
Grade 2 Inverted Nipple
Grade 2 inverted nipples are more difficult to pull out than a grade 1. Unlike grade 1, when released, the nipple in grade 2 inversion retracts inward.
In this grade, the lactiferous ducts are mildly retracted and do not need to be cut in order to release the fibrosis. They have a moderate degree of fibrosis.
Grade 3 Inverted Nipple
Grade 3 inverted nipples can rarely be pulled out physically. The nipples are severely retracted and it requires surgery in order to be pulled out.
In this grade, milk ducts are often constricted and breast feeding is not possible. The breast has considerable fibrosis and lactiferous ducts are severely retracted and short.
Due to the fact that the nipples cannot be pulled out, people with Grade 3 inverted nipples may experience problems with nipple hygiene. As a result, they may often get infections and rashes in their nipples or breast.
Inverted nipples Grade Self-test
You can perform a simple pinch test for your nipples to find out which grade they belong to. This test is especially for women.
Just hold your breast around the edge of the areola between your thumb and index finger. Press inward gently but firmly, about an inch behind your nipple.
Testing for inverted nipples grade
- If it protrudes easily, it is considered a grade 1 inversion
- If it does hardly protrudes but does not retract, it is considered a grade 2 invasion.
- If it retracts or does not protrude at all, it is considered a grade 3 inversion.
Flat Nipples vs Inverted Nipples
The term ‘flat nipples‘ is also widely used to talk about nipple retraction. However, it is generally used to refer to moderately inverted nipples, specifically grade 1 and grade 2 inversion. Often, those who use it try to distinguish between ‘flat nipples’ (grade 1 and grade 2 inversion) and ‘truly inverted nipples’ (grade 3 inversion).
Normal, flat nipple and inverted nipple
Therefore, flat nipples are moderately inverted nipples, although the terms are sometimes used interchangeably. For the purpose of our discussion, the term ‘flat nipples’ is used to refer to grade 1 and 2 inverted nipples.
The Inverted Nipple Correction Advantage
A problem with inverted nipples can lead to problems with self-consciousness and embarrassment. However, inverted nipples can also cause problems beyond aesthetic concerns. They can lead to frustrating issues with breastfeeding, infections, and other physical discomfort. Most people don’t know that this is a readily correctable problem with nipple reconstruction.
What is Inverted Nipple Correction Procedure
Niplette: For women (or men) with the lowest levels of nipple inversion, there are some non-surgical temporary fixes available. Using suction devices that place constant pressure on the nipple provides a temporary solution, but doesn’t correct the underlying structural issues that are causing the nipples to retract.
The Niplette is a gentle instrument that uses gentle suction to draw the inverted nipple out, and remain erect.
The permanent fix for inverted nipples is surgery. This is a procedure that is performed under local freezing (anesthesia) and takes about 30 minutes.
During this procedure, a small incision is made under the nipple to allow the surgeon to cut the mild ducts which are tethering the nipple. This will lead to loss of the ability to breast feed. This is accomplished by making a small incision in the areola while the nipple is held in the extended position.
After the tissues are transected, several lines of dissolving sutures are placed under the skin to hold the nipple in the projected position. Once this is done, protective devices are placed over the nipples to hold them in position, and prevent them from retracting again during healing. There is a 5% risk of sutures breaking leading to a recurrence and the need for a repeat correction.
During the procedure, we will over-correct the nipple protrusion (they will look excessively large) because we expect some settling. This is normal. Your final result will not be excessively protruding nipples. As your swelling settles over the next 2-4 weeks, your nipples will attain their intended normal shape and size.
At two weeks, you will return to see the doctor to have your special protective dressing changed.
After the first post-operative visit, you will see at almost 12 weeks. If your nipples have maintained their position by this time, it is unlikely they will revert and no further visits are required.