Inverted nipples?

Dear Inside-out,

“Innies” and “outies” (nipples, of course) rejoice! Inverted nipples are one of the many variations of the human body that make each person unique. Some people may feel awkward about having "innies" because their nipples look different, or appear to be hiding or shy. Fortunately, no medical problems are associated with being born with inverted nipples; however, one thing to note is that for some women, inverted nipples can sometimes make it difficult to breast feed since a baby latches on more easily to an erect nipple. However, most inverted or flat nipples will not cause problems during breastfeeding.

Inverted nipples can be either temporary or permanent. A truly inverted nipple is caused by adhesions at the base of the nipple that bind the skin to the underlying tissue. It is also possible to have an inverted nipple on one breast, but not the other. To test whether you do indeed have inverted nipples, you can try the "pinch" test. Hold your breast at the edge of the areola between your thumb and index finger. Press in gently but firmly about an inch behind your nipple. If your nipple protrudes, that’s great. If it does not protrude or become erect, it is considered flat. If it retracts or disappears, it is truly inverted.

Though only a temporary fix, nipple stimulation and low temperatures may succeed at drawing out an inverted nipple. The only way to permanently change "innies" to "outies" is through plastic surgery (although some women have reported a permanent protraction to the "outie" state after breastfeeding). Going under the knife is only recommended for healthy people over age 18, women who are neither pregnant nor breast feeding, and for patients having the surgery for the first time. However, these procedures are expensive (ranging from about two to five thousand dollars), and there is still a chance that nipples will revert to their former orientation. This is particularly true for people who develop inverted nipples later in life.

Have you always had inverted nipples? Developing inverted nipples later in life may be a symptom of a more serious medical condition, such as Paget's disease of the breast. This condition primarily affects women over age 50 and is a rare form of breast cancer in which the ducts beneath the areola or in some rare cases, the nipple itself, have been affected by cancer. While breast cancer rarer in men than in women, it can also occur in men. There is also a less severe condition, mammary duct ectasia, which is an inflammation and sometimes infection of the mammary ducts. This condition is usually more present in women over 50 as it is typically caused by hormonal changes. Inversion of the nipples can also indicate disorders of the breast, such as breast abscess, fat necrosis, and mastitis.

If your nipples have gone from protracted to inverted, it is a good idea to speak with a healthcare provider.

Here’s to loving your nipples — “innies” and “outies” alike!