Dear Women, Don’t Shy Away From Inverted Nipple Correction

Inverted nipple deformity is an extremely common deformity affecting roughly every 1 in 30 women and can cause not only embarrassment, low self esteem but can also make it difficult or even impossible to breastfeed. It often affects both breasts but in some patients it may involve only one side. Better understanding of the problem and available solutions can educate women and avoid unnecessary suffering.

What Causes Inverted Nipples?

The nipple is composed of milk ducts and smooth muscle cells. “Fibrosis’ causes shortening of ducts and this imbalance pulls the nipple inwards even when the muscle is trying to make it protrude out. Normal nipple stands out when the surface is stroked, stimulated or subjected to cold.

Are Inverted Nipples a Sign of Breast Cancer?

Long standing inverted nipple deformity is a developmental benign deformity but any sudden appearance of inversion in a previously normal nipple should be taken as an alarming sign and a medical consultation sought.

Can One Breastfeed With Inverted Nipples?

It may be possible for you to breastfeed even if your nipples are inverted, but it is dependent on the severity of the nipple inversion or the grade.

Classification of Inverted Nipples

Inverted nipples are classified into three grades:

1. Flat or Grade 1 Inverted Nipple Deformity

This exhibits the mildest degree of inversion wherein the nipple may be made to stand out on exerting finger pressure around its base and pulling it out manually and would then remain out by it self.

These are essentially ‘Shy Nipples’. They have minimal or no fibrosis and milk ducts may be perfectly normal and patients can breastfeed.

These essentially need no treatment and simple manual stretching and stroking few minutes everyday may keep them in normal position.

2. Indented or Grade 2 Inverted Nipple Deformity

These type of nipples can be pulled out with some difficulty but will retract as soon as the pressure is released.

Although breast-feeding maybe possible, baby may find it difficult to latch on and it can be frustrating for both mother and the baby.

Nipple suction devices like ‘Nipplette’ can sometimes help but fail to give a permanent correction. Advanced plastic surgery techniques allow ‘duct sparing’ correction of inverted nipple.

This should be done either before one becomes pregnant or at least before the third trimester and can be done even under local anaesthetic as a daycare procedure. Our innovation of ‘Nipple syringe splint’ and its modifications both published in the prestigious Plastic & Reconstructive Surgery International Journal has been successfully used to treat many such cases of inverted nipple deformity.

3. Tucked-in or Grade 3 Inverted Nipple Deformity

This represents the most severe type wherein the nipple just cannot be pulled out. This is caused by severe fibrosis of the milk ducts and it is unlikely that these women will be able to breastfeed.

Women with such deformity often have difficulty in maintaining good nipple hygiene. This deformity can be easily corrected with surgery by dividing the short milk ducts but patients are duly informed that they cannot breastfeed after the surgery.

Inverted nipple deformity is extremely common, can be emotionally distressing and cause difficulty in breast-feeding. In most cases, many women are quite unaware of the problem till they become pregnant.

Surgical corrections, however, can give satisfactory long-term results and can even be conducted among pregnant women before their third trimester.

(Dr Sunil Choudhary is the Senior Director & Chief of Plastic Surgery, Max Institute of Reconstructive, Aesthetic, Cleft & Craniofacial Surgery (MIRACLES), Max Super Speciality Hospital, Saket)

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