Inverted nipples: Treatment options

Inverted nipples are defined as a condition where the nipples are retracted and do not point outward. The condition may involve one nipple or both, affecting as many as 2% of the women. It can cause aesthetic problems and compromise the ability to breastfeed. The problem is usually congenital ( in rare cases it may be the result of inflammatory processes, surgery or breast cancer), and is determined by the presence of short lactiferous ducts (milk ducts) that pull the nipple toward the mammary gland, inside the breast.

Surgical treatments

The most common treatment for inverted nipples is perhaps the surgical section of the milk ducts, which eliminates the cause of retraction. This solution would normally compromise the ability to breastfeed. Other types of surgery include the harvesting of small skin flaps or the use of sutures to narrow the base of the nipple and prevent its retraction. The effects of these procedures are normally temporary unless the milk ducts are interrupted at the same time.

Non-Surgical Treatments

The most common non-surgical treatment for the correction of inverted nipples is the application of a small “suction cup” (sold under the commercial name of Niplette), which keeps the nipple everted. While apparently very logical and simple, this treatment  is generally not well accepted by women (the device is fairly visible under clothes and must be worn 8 hours during the day or at night) and can have mild but annoying complications, such as the ulceration of the nipple.

‘Contemporary’ treatments

In 2001 Erick Sholten described a novel treatment for inverted nipples,  using a simple and quite fashionable method to retain the nipple in position: a piercing. With a simple procedure under local anaesthesia, a barbell-shaped piercing of appropriate length and caliber can be used to keep the nipple everted, without cutting the milk ducts and normally without compromising breastfeeding. A published study on this type of treatment (32 cases of inverted nipple), reported aesthetically pleasing and functionally satisfactory results, with no complications.

What treatment for inverted nipples?

Due to its simplicity and effectiveness, piercing seems to offer several advantages. The choice of  traditional surgical procedures with flaps or sutures should be reserved for those who do not want to breastfeed in future or that cannot tolerate the idea of having a piercing. Suction systems (Niplette) do not seem advisable in general, and should be reserved for those women that, for whatever reason, do not want to undergo invasive procedures of any kind, including a very simple piercing.

Where can I have a piercing done, and how much does it cost?

While it is possible to have a nipple piercing in a normal piercing shop, this may not be the best choice when the goal is the correction of the retraction and not purely cosmetic. The procedure is much more comfortable if performed under local anaesthesia, in a clinical environment, and the risks of infection or migration of the piercing through the skin are reduced to the minimum. The cost of a medical piercing for the correction of inverted nipples is 600 KYD for a single nipple and 1,o00 KYD for both.

References

Sholten E. A contemporary correction of inverted nipples. Plast. Reconstr. Surg. 107:511-513, 2001

Terrill, P. J., and Stapleton, M. J. The inverted nipple: To cut the ducts or not? Br. J. Plast. Surg. 44: 372,1991

Megumi, Y. Correction of inverted nipple with periductal fibrous flaps. Plast. Reconstr. Surg. 88: 342,1991

Gangal, H. T., and Gangal, M. H. Suction method for correcting flat nipples or inverted nipples. Plast. Reconstr. Surg. 61: 294,1978

McGeorge, D. D. The “Niplette”: An instrument for the non-surgical correction of inverted nipples. Br. J. Plast. Surg. 47: 46,1994