Medical Edge Newspaper Column

Options for Correction of Inverted Nipples

October 8, 2007
Dear Mayo Clinic:
Can you correct inverted nipples?

Answer:
An inverted nipple — one that turns inward — can cause a number of problems. One potential problem is difficulty breast-feeding. Another is that an inverted nipple can be hard to clean, and the nipple and the skin around it (areola) can become inflamed and irritated. And, some women just don't like the look of an inverted nipple. Usually, inverted nipples can be corrected with surgery. Before exploring surgical options, though, make sure there isn't a medical problem causing nipple inversion.

For many people with this condition, the nipple has been inverted since birth (a congenital condition). Or, the condition could have resulted from a breast biopsy or surgery. In these situations, there probably isn't an underlying problem. And occasionally, an inverted nipple can spontaneously resolve, such as after a pregnancy or even years after a surgical biopsy. But a nipple that has become inverted, or an inverted nipple that has retracted further than usual could be a sign of breast cancer or another breast problem, such as an infection of the breast tissue (mastitis). In either case, make an appointment with your health care provider for a clinical breast exam and evaluation. Your health care provider also may recommend that you have a mammogram or other breast imaging tests. Depending on those findings, a biopsy may be necessary, as well.

Once an underlying medical condition has been ruled out, your health care provider can refer you to a plastic surgeon who will evaluate your condition and discuss surgical options for correcting the inverted nipple.

The condition usually is caused by ducts within the nipple (lactiferous ducts) that are shorter, fewer in number and more fibrous than normal and thus pull the nipple inward. The procedure to correct this problem involves releasing the retracted, fibrous tissue and allowing the nipple to heal in an outward, projecting position. Several surgical techniques are available. The extent and type of surgery you have will depend on how far your nipple is inverted.

Although surgery can change the appearance of the nipple, breast-feeding may still be difficult. Also, in some cases, the condition may recur after you've had surgery due to recurrence of the underlying problem, scar tissue from the surgery or inadequate release. Before you undergo surgery to correct an inverted nipple, discuss the risks and benefits with your plastic surgeon.

— Molly Walsh, D.O, Plastic Surgery, and Sandhya Pruthi, M.D., Breast Diagnostic Clinic, Mayo Clinic, Rochester, Minn.