As many as 3% of Australian women have at least 1 inverted nipple but the subject of nipple inversion is seldom discussed amongst family, friends or the media. Clearly, nipples are an integral part of the breast, playing a role in appearance, in sexuality, and in motherhood. Therefore, many women who have inverted nipples, feel that it aﬀects their self-esteem and body image.
Most cases of inverted nipples are just born that way (congenital). However, some nipples become inverted after breastfeeding when scar tissue builds in the milk ducts. Nipples that become inverted after birth are usually caused by one of three things: not enough skin at the base of the nipple, constricted milk ducts, or scarring of the milk ducts due to breastfeeding. There are 2 types of inverted nipples: shy and densely inverted.
- Shy inverted nipples– can be drawn out with physical stimulation, either sexually or for breastfeeding. Shy inverted nipples may only cause cosmetic and psychological problems.
- Densely inverted nipples– this is where the nipples never come out, even when aroused or in very cold water. Densely inverted nipples also have functional repercussions, such as the inability to breastfeed, infection or irritation of the nipple when natural secretions become trapped.While a procedure to correct inverted nipples can have a great impact on the patient’s psyche and correct irritation problems, the ability to breastfeed cannot be guaranteed, as some or all of the ducts may need to be divided in order to free the nipple so that it is drawn out completely. The particular technique I use to correct inverted nipples was taught to me by my colleague and friend Dr. Grant Stevens, a plastic surgeon in Los Angeles, who is a pioneer in new techniques for procedures in breast surgery. The technique is safe, eﬀective, has a short downtime, and the results are long-lasting. Before the procedure begins, the nipple and areola are numbed with an ice cube or pack, and a local anaesthetic given using a tiny needle the size of a hair. This means the patient experiences little or no pain, despite the sensitivity of the area.
The surgery itself is broken into 3 stages:
Stage 1: an incision measuring 4 to 5 mm is made in the lower portion of the nipple. The ﬁbres or ducts are then released that are pulling the nipple down. The nipple is drawn out with much care in order to preserve the ability to breastfeed.
Stage 2: involves a series of stitches around the nipple. If the nipple is imagined like a clock, the stitches run from 12 to 6 o’clock, then again from 3 to 9 o’clock. By bunching up the tissue around the nipple, these stitches create a new pedestal for the nipple to rest on. A dissolving “purse-string” stitch is made around the base of the nipple, weaving in and out of the skin, which tightens the base of the nipple.
Stage 3: a small plastic “stent” – like a tiny medicine cup – is placed over the newly extracted nipple. This stent actually holds the nipple in place and ensures that the nipple heals in an outward position. Not only does it help with the nipples’ projection, but it also protects the nipple in the healing stages. This stent is kept on for 1 to 3 days. The patient then returns for a follow-up visit to remove the stent and the process is complete.
Post-operatively, there is little care needed. While the stent is on, patients cannot get the area wet and sexual contact is discouraged for the ﬁrst week after surgery. Occasionally, the patient may need an ointment to aid the healing, although this is rare. The wound heals very quickly – to the point where the scar is usually invisible by the time the patient returns to have the stent removed (the stitches dissolve within 10 to 14 days). Possible complications include the retraction of the nipple or a local infection.
Although the correction of inverted nipples is a procedure that can greatly assist both the self-esteem of the suﬀerer and the function of the breast, more and more women are coming to my practice seeking nipple surgery for repair, correction, and enhancement of other conditions too:
- Enlarged nipples can be corrected with simple outpatient surgery reducing the length or diameter of one or both nipples.
- Reducing enlarged areolas is a quick ﬁx as the areola can impact the appearance of the breasts more than any other feature.
- “Puﬀy” areolas put a cone-like cap on the breasts that some people ﬁnd unattractive. A simple surgery can ﬂatten the areola and beautify the breasts.
So despite the fact that nipples are usually hidden, women still want them to look attractive. Many women suﬀer with nipple and areola abnormalities such as inverted nipples, enlarged nipples, and puffy, enlarged or discoloured areolas. Many of these conditions can impact breast function, but they all impact the way women feel about their bodies. The nipple can be repaired during outpatient surgery or during breast enhancement surgery.
Question: Do women feel inverted nipples is such a big issue to warrant surgery? You can leave a comment below.