Inverted Nipples, Retracted Nipples, and Nipple Changes

What Nipple Findings are Normal and What are Not?

Just as women differ in height and other body features, there are significant variations in the appearance of the nipples and breasts.

At the same time, you may have heard that problems such as retracted nipples may be a sign of breast cancer. Here's what you need to know about nipple variations such as inverted nipples, retracted nipples, and erect nipples. When may these changes be normal and when do you need to call your doctor?

 

Normal Nipples and Nipple Variations

Nipples and areolas can vary in size, shape, and coloration.

"Normal" nipples are the ones you were given at birth—flat, puffy, shy, or prominent—they occupy a place of honor on your breasts. Nipples can change in response to hormonal changes during puberty, pregnancy, and breastfeeding.

Remember to examine your nipples as part of your monthly breast self-exam, as you check for changes. Know when to get medical help, if nipple changes occur. Let's take a look at some common variations on nipples.

Erect or Everted Nipples

Everted Nipple - Erect Nipple
Everted Erect Nipple. Art © Pam Stephan

Most of us think of everted nipples—raised tissue in the center of your areola—​as normal nipples. Even when your skin is at normal body temperature, an everted nipple will stand out from the skin of your breast—even if it has not been stimulated. It is held erect by a cylindrical column of small smooth muscles.

Everted nipples present little difficulty for a breastfeeding mother and infant. Nipples which are not everted, however, can make breastfeeding difficult. Thankfully, lactation experts have come up with a number of different ways to get around this. Check out these tips on how to breastfeed with flat nipples.

When everted nipples are stimulated by touch or cold, they may become erect. Everted nipples are more prone to Jogger's Nipple, but with proper care, this can be prevented.

Inverted Nipples

Inverted Nipple
Inverted Nipple. Art © Pam Stephan

Inverted nipples appear to be indented in your areola, instead of standing up above the surface of your breast. Nipple inversion is a condition that you are born with and it does not mean you have breast cancer.

Nipple inversion may occur because the nipples are stuck to scar tissue or the nipples may be connected to a short milk duct. 

Some people find inverted nipples very distressing, and there are several options for correcting these. Nipple retraction is usually described as being one of three stages, depending on the degree of inversion and mobility of the nipple.

For mild inversion (grade 1), inverted nipples can sometimes be coaxed out of hiding with some stimulation; various devices for self-retraction as well as vacuum approaches have been used. The results of these treatments, however, are usually modest at best and are not usually a long term solution.

Plastic surgery can be done to reverse inverted nipples. A number of different procedures have been used. If you are considering this, find a plastic surgeon who has experience in treating nipple inversion. Ask if you can see any before and after pictures of other women who have had the procedure done. You may want to get a second opinion as well.

Nipple inversion which isn't present from birth, and is a change from your normal everted nipples, however, should be evaluated by your doctor. This condition would usually be referred to as nipple retraction (see below).

Retracted Nipples: A Changed Position

Retracted Nipple
Retracted Nipple. Art © Pam Stephan

Retracted nipples are a nipple change. When your nipple starts out as raised tissue but begins to pull inward, change position, or fold itself into a narrow crease, you have a retracted nipple. 

A retracted nipple, unlike an inverted nipple, will not come back out when stimulated. Nipple retraction may be caused by aging, duct ectasia, or breast cancer. See your doctor if you notice nipple retraction, especially if only one nipple is affected. 

A mammogram or breast ultrasound will help determine the cause of the nipple change and enable you to get the proper treatment.

Bottom Line on Nipple Changes

Nipples, like the rest of our bodies, change as we grow, mature, and age.  It's good to know what is normal for your nipples. Do keep up your monthly breast self-exam so you will recognize changes. Keep an eye out for nipple discharge, lumps, blisters, or unusual pain. Get help if you find an unexpected change in your nipples and areolas.

Sources:

Hernandez Yenty, Q., Jurgens, W., van Zuijlen, P., de Vet, H., and P. Verhaegen. Treatment of the Benign Inverted Nipple: A Systematic Review and Recommendations for Future Therapy. Breast. Epub 2016 Jul 29.

Yukun, L., Ke, G., and S. Jiaming. Application of Nipple Retractor for Correction of Nipple Inversion: A 10-Year Experience. Aesthetic Plastic Surgery. 2016. 40(5):707-15.

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