Inverted nipple
A nipple retracted into the breast, graded by protractability and fibrosis.
An inverted nipple is a condition in which the nipple is retracted into the breast rather than pointing outward. It can occur in both women and men, and in some cases the nipple may protrude temporarily when stimulated.
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- Gynecology
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Grading system
Inverted nipples are classified into three grades based on how easily the nipple can be protracted and the degree of fibrosis present, as well as damage to the milk ducts. Grade 1 nipples can be pulled out easily using finger pressure around the areola; they maintain projection, rarely retract, and may occasionally pop up without manipulation. Milk ducts are usually not compromised, breastfeeding is possible, and there is minimal or no fibrosis with no soft-tissue deficiency. Grade 2 nipples can be pulled out but not as easily as grade 1, and they retract after pressure is released. Breastfeeding is usually possible but may be harder initially; these nipples have moderate fibrosis and mildly retracted lactiferous ducts that do not require cutting for release. Histologically, they show rich collagenous stromata with numerous bundles of smooth muscle. Grade 3 nipples are severely inverted and retracted, rarely can be pulled out physically, and require surgery for protraction. Milk ducts are often constricted, breastfeeding is difficult but not impossible, and women may struggle with infections, rashes, or hygiene problems. Fibrosis is remarkable, lactiferous ducts are short and severely retracted, soft tissue is markedly insufficient, and histologically atrophic terminal duct lobular units and severe fibrosis are seen.
Pregnancy and breastfeeding
Women with inverted nipples may find their nipples protract temporarily or permanently during pregnancy or as a result of breastfeeding. Most are able to breastfeed without complication, though inexperienced mothers may experience higher than average pain and soreness initially. Proper breastfeeding technique involves latching onto the areola, not the nipple, so inverted nipples do not necessarily prevent breastfeeding. An infant that latches well may draw out an inverted nipple, and using a breast pump or other suction device before feeding can help. Some women use a nipple shield, and frequent stimulation such as sexual intercourse or foreplay may also help the nipple protract.
Other corrective strategies
Strategies for protracting inverted nipples include regularly stimulating the nipples to a protruding state to gradually loosen tissue. Sex toys designed for nipple stimulation, such as suction cups or clamps, may cause inverted nipples to protract or stay protracted longer. Special devices or a homemade nipple protractor from a 10-ml disposable syringe are also used, often in preparation for breastfeeding. One method now discouraged is the use of breast shells, which apply gentle constant pressure to the areola to break adhesions; a 1992 study found that shells do not promote more successful breastfeeding and may actually disrupt it.
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