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Inverted nipple causes

Inverted nipple is a condition in which the nipple is pulled inward into the breast instead of pointing outward. Any nipple that is more indented than protruding could be identified as inverted nipple. Some experts call it “nipple inversion” or “nipple retraction” or “invaginated nipple”. About 10-15% women could have inverted nipples or “flat nipples” (nipples that lie flat against the areola, instead of sticking out). It could be shy or truly inverted nipple – defined by a three-level grading system and causes could be different. Cosmetic surgery can be used to correct this condition but there are few important points which should be clarified:

  • do you have inverted nipples from birth/puberty (congenital);
  • do you have inverted nipples on both sides;
  • is inverted nipple a result of disease or trauma;
  • are nipples inverted only some of the time and “pop out” after stimulation or changes in the temperature;
  • did your one nipple became inverted without any visible reason (most dangerous, could be sign of breast cancer).

General inverted nipple causes

Nipple inversion is determined by the balance between muscle contraction inside the nipple which pushes it outwards and the inward pulling of milk ducts. Usually nipple can be inverted when the pull of the milk ducts becomes stronger than the muscle inside the nipple.

General causes of inverted nipples include the following:

  • Congenital (inherited) – when women have inverted nipples by birth;
  • Breast cancer – when normal nipple on one side becomes inverted unexpectedly;
  • Aging (breast sagging) – when breast skin sags and the skin around the nipples become loose (leading to inversion);
  • Previous breast surgery for several reasons – causing scar tissue formation and nipple inversion;
  • Breast infections – triggering inflammation and resulting in fibrous scar tissue pulling the nipple inwards;
  • Breastfeeding – when milk ducts can be damaged and transformed into fibrous tissue which can pull the nipples inwards;
  • Pregnancy – when breasts and nipples transformed (check “Breast changes during pregnancy”).
Normal, flat and inverted nipple

Normal, flat and inverted nipple

Grade I inverted nipple

Grade I is the mildest form of inverted nipple – it is classified by flat (“shy”) or slightly inverted nipples, usually become normal (“pop out”) after stimulated by touch or temperature changes.

Grade I inverted nipples usually have no serious reasons. Cold touch (ice touch) or nipple massage or nipple pinch could be easy solution.

Women with grade I inverted nipples usually have no problems during breastfeeding because the milk ducts remain unaffected.

Grade II inverted nipple

Grade II inverted nipples have more inverted appearance. When pinched or stimulated by ice could become normal but only for very short period.

Main causes of grade II inverted nipples are fibrosis and mild retraction of the milk ducts. This means that the nipple is constantly being pulled inwards by fibrous tissue into the breast causing it to be inverted.

Women with grade II inverted nipples could create problems during breastfeeding because milk ducts are involved.

Grade III inverted nipple

Grade III inverted nipples (“truly inverted nipples “) are the most severe with very short milk ducts and permanent inversion. It is impossible to change the situation with cold, massage or pinch.

Severe fibrosis and short milk ducts are the main causes of grade III inverted nipples – because of short milk duct the nipple is pulled inward and physically attached to tissue within the breast and so protraction is virtually impossible without surgery.

Women with grade III inverted nipples cannot breastfeed babies without surgical interventions.


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