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An inverted nipple refers to the nipple, which is retracted into the breast instead of pointing outwards. This can be either a temporary situation, wherein the nipple may protrude out with stimulation or a permanent one where the nipple remains retracted

Introduction 

Inverted nipple/s can occur owing to a variety of causes. These can be broadly classified as congenital (present since birth) or acquired (that develops later during the lifetime). Some of the possible causes under these two categories have been listed below.

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Congenital Inverted Nipples (Since Birth)

  • Chromosome 2q deletion syndrome.
  • Congenital disorder of glycosylation. 
  • Congenital disorder of glycosylation type 1A.  
  • Congenital disorder of glycosylation type 1L.  
  • Fryns-Aftimos syndrome.  
  • Genetically determined difference in the shape of nipple. 
  • Weaver Syndrome. 
  • Kennerknecht-Sorgo-Oberhoffer syndrome.

Chromosome 2q Deletion Syndrome

This syndrome involves deletion of certain specific cell structures known as chromosomes that carry details of the hereditary structures of the body design and function. Absence of chromosome 2q is associated with a wide variety of symptoms such as mental retardation, characteristic facial appearance, and behavioral manifestations. The presence of abnormal nipples, including inverted nipples has been observed in many individuals.

Congenital Disorder of Glycosylation

This disorder is characterized by an inborn defect of certain tissue proteins that may affect the functioning of the various organs and tissues such as the nervous system, intestines and muscles in the body. The common features include increased occurrence of seizures, eye disorders, liver disorder and many more. Presence of inverted nipples is also a common feature in this disorder. Many variants of this disorder have been identified among which congenital disorder of glycosylation type 1A and congenital disorder of glycosylation type 1L are also associated with the occurrence of nipple inversion.

Fryns-Aftimos Syndrome

This is a rare disorder which is mainly characterized by features such as abnormal brain development, epilepsy, mental retardation and unusual facial appearance. This syndrome is also associated with multiple inborn defects of the body structures among which the presence of inverted nipples is also significantly noted.

Genetically Determined Difference in the Shape of Nipple

The shape and structure of all the organs and organ systems in our body are determined genetically. Many of these structural details are passed on through the generations. The shape of the breast, its size, position of nipple and their numbers are also genetically determined. Any alteration in the basic genes or the presence of a predetermined gene that governs the shape and size of the nipples can cause the nipples to be inverted.

Weaver Syndrome

Weaver syndrome is characterized by a wide variety of features that include large size of the baby at birth, faster growth and maturation, abnormalities of the hands and legs, head and facial region, nervous system and other abnormalities such as loose skin, low-pitched voice and inverted nipples.

Kennerknecht-Sorgo-Oberhoffer Syndrome

This syndrome is mainly characterized by the absence of testicles in case of men and ovaries in case of women. Other associated features include underdevelopment of the right-side portions of the heart, lungs and some blood vessels. Inversion of the nipples is also noticed in individuals affected by this syndrome along with other features such as unusual facial structure, short neck and webbing of the toes.

Acquired (Develop Later)

  • Breast abscess. 
  • Breast cancer (breast carcinoma).
  • Inflammatory breast cancer.
  • Pregnancy. 
  • Breastfeeding. 
  • Fat necrosis. 
  • Holoprosencephaly, recurrent infections, and monocytosis. 
  • Tuberculosis. 
  • Mammary duct ectasia. 
  • Mastitis. 
  • Paget’s disease.
  • Surgical injury.

Breast Disorders

Disorders of the breast such as breast abscess (collection of pus within the cells and tissues of the breast), fat necrosis (destruction of the fat tissues in the breast), mammary duct ectasia (expansion of the specialized structures in the breast known as mammary ducts that transport the milk produced in the breast), and mastitis (infection or inflammation of the breast tissues and structures) have all been associated with occurrence of nipple inversion. In most of the cases, correction of these disorders will make the nipples to be protracted back.

General Diseases

Holoprosencephaly, recurrent infections, and monocytosis is a group of disorders that is characterized by abnormal development of the brain, recurrent infections of the skin and respiratory system, increased concentration of certain blood cells known as monocytes and inversion of nipples. Other disorders such as tuberculosis and Paget’s disease have also been associated with the presence of inverted nipples.

Cancer

Cancer refers to an abnormal growth of cells and tissues in the affected part of the body. Breast cancer can often be characterized by different symptoms such as discharge from the nipples, inversion of the nipples, changes in the shape and consistency of the breast tissues.

Pregnancy and Breastfeeding

In certain rare cases, the nipple may invert during pregnancy and breast feeding. This may be observed due to an increase in the size of the breast that is normally noted during this period in a woman’s life.

Surgical injury

Nipple inversion can occur in certain individuals as a complication of surgeries involving the breast in general or those which involve the nipples in specific.  

Methods to Protract Inverted Nipples

The correction of inverted nipples may either be sought for cosmetic reasons or to aid in breastfeeding of infants. The treatment involves either self stimulation of the nipples or surgical correction.

Self-Stimulation

During the self-stimulation, the inverted nipple is stretched and rolled out several times a day. A plastic syringe can also be used to draw out the nipple. If the woman is breastfeeding, regular stretching out the nipple followed by breastfeeding the infant can usually result in permanent nipple protraction. Certain suction cups and clamps designed to protract the nipple are also available, which have been found to be useful in certain cases.

Surgical Correction

If the self-treatment procedures fail to protract the inverted nipples, surgical correction can be tried. This procedure has been tried widely and has varied results. Plastic surgery is the surgical method used to correct the inverted nipples. During this procedure, which is generally done under local anesthesia, an incision is placed over the breast near the base of the nipple, the inverted nipple is protracted and sutures are placed to prevent it from retracting in again. If the sutures are placed with self-dissolving material, you may not require visiting the doctor again for removal of the sutures. The wound heals within about 2 week’s time and the scar may be very minimal or even not visible.

Best Candidate for Surgical Correction

The following characteristics are considered to be advantageous while considering surgery for the correction of inverted nipples:

  • Women of the age group 18 years or older.
  • Women who are not pregnant or breastfeeding their child.
  • Women who are healthy and stable psychologically.
  • Women who understand the pros and cons of the surgery.
  • Women who are having this corrective surgery for the first time.

Complications of Surgical Correction

When performed by an experienced surgeon, nipple inversion correction is usually quite successful. However, when performed by inexperienced surgeons or in other very rare cases, certain complications may be associated with this surgical procedure. The commonly noted ones include:

  • Re-inversion of the protracted nipple.
  • Infection at the surgical site.
  • Bleeding from the skin wound.
  • Injury to the skin around the nipple.
  • Side-effects to anesthesia such as temporary or loss of breast sensation for up to a year.
  • Scars that remain.
  • Slight mismatch in the size of the nipples.
  • Permanent disability to breastfeed.

  • en.wikipedia.org/wiki/Inverted_nipple
  • www.wrongdiagnosis.com/symptoms/inverted_nipple_nipple_retraction/causes.htm
  • www.nipplerepair.com/inverted-nipple-repair.cfm
  • www.prplastic.com/inverted_nipple_2.htm