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Flat or Inverted Nipples

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Overview

Nipples can vary in size and shape from woman to woman. Although certain characteristics are common amongst healthy nipples. It is supposed to protrude outwards when at rest and become erect when exposed to stimuli such as touch, cold, or sexual activity. In certain cases, women may have what is called flat or inverted nipples.  

Types of Nipples

Based on the general characteristics, nipples can be classified as 

  1. Common Nipples
    Most women have “common nipples”. Even this classification has several variations in the physical characteristics that define common nipples. A common nipple is supposed to project outwards in its relaxed state. Due to the fact that there are a lot of nerve endings in them, they become erect if stimulated. They can face front, sideways or even be a mismatched pair amongst many women. They can also vary in their colour (ranging from very pale pink to very dark brown, sometimes they darken further during pregnancy)  
  2. Inverted Nipples
    These types of nipples lack the usual protrusion. It is usually a congenital condition and occurs when the breast tissue adheres to the base of the nipple too tightly. It can also be a result of shortening of the milk ducts. 
    In case this condition was congenital, it is considered harmless although it can complicate breastfeeding. If they are acquired, (commonly called acquired nipple retraction), additional tests should be done to diagnose the cause of the condition.  
  3. Flat Nipples
    These types of nipples are not raised. They don’t respond to external stimuli and lay flat with the areola. If the nipple appears flat when relaxed, but they respond to touch or change in temperature by becoming erect, they are not considered flat nipples.  
  4. Retracted Nipples
    This is an acquired condition wherein the nipple starts pulling inward, changing position or in some cases folds itself into a narrow crease. Unlike inverted nipples, this will not react to external stimuli. Consult your doctor at the earliest if you notice retracted nipples, especially if it is present only in one breast, it can be an early sign of breast cancer. 

About The Condition

Nipples can undergo significant change with age. They also vary in shape, size and colour from person to person. So, it is important to be familiar with your “normal”. Nipple conditions are usually benign and are rarely an indicator for cancer, especially if it’s the only symptom. However, if the condition persists, seek medical attention to rule out any underlying conditions.  

Risks of Flat/Inverted Nipples

As these nipple abnormalities are either congenital or a symptom of an underlying condition, there are no set predefined risk factors to identify people more prone to developing inverted or retracted nipples. However, a few of the risk factors identified are: 

  1. Aging: Nipple retraction can occur naturally with age, especially after menopause. This is a benign condition and does not necessarily indicate breast cancer.  
  2. Mammary duct ectasia: This is a condition that occurs during perimenopause. It is caused by the widening and thickening of the milk duct. It usually causes redness, sensitivity and nipple discharge along with a retracted nipple 
  3. Paget’s disease of the nipple: This is a rare form of breast cancer that occurs in menopausal women. Retraction of the nipple is not the only symptom for this condition, it is accompanied by dryness, flaky skin, itching, oozing and nipple discharge. You might also feel a lump on or near your nipple.  

Symptoms

In the case of benign conditions, you might not experience any additional symptoms accompanying inverted or flat nipples. However, keep an eye out for the following symptoms that can appear in any one or both of the nipples in case of an underlying condition: 

  1. Lump near or under the nipple 
  2. Bloody or brown nipple discharge 
  3. Soreness in the nipple or surrounding breast tissue 
  4. Red or flaky nipples 
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If you are noticing any of the above symptoms, seek medical attention at the earliest to get effective treatment. Most breast conditions can be easily treated if caught in the early stages. Hence, time is of the essence to manage and treat breast conditions. 

Diagnosis of Flat/Inverted Nipples

You can diagnose inverted or flat nipples at home by performing a simple check called the “pinch test”. In this test, you have to gently compress your nipple/areola. If it doesn’t respond to the stimulus by becoming erect, it is considered to be a flat nipple. If it retracts, it is classified as an inverted nipple.  

In case you experience other symptoms apart from inverted or flat nipples such as nipple discharge, swelling, redness among others, your doctor might recommend additional diagnostic tests to identify the underlying conditions. These tests may include 

  1. Imaging Scans: Scans such as ultrasound and mammograms are used to discern any abnormal growths (lumps) in the breast tissue.  
  2. Needle Biopsy: In this test, samples of the breast tissue are taken and studied under a microscope to detect any abnormal (cancer) cells.  
  3. CT scan/MRI: These are advanced imaging scans to detect any blockages or growths in the breast tissue.  

Treatment of Flat or Inverted Nipples

Congenital flat or retracted nipples that are not caused by an underlying condition does not necessarily require medical intervention. However, in case the patient desires to correct the condition for aesthetic reasons they can so by the following treatments: 

  1. Suction Devices
    These offer a temporary fix. They are worn under clothing for extended periods of time to draw the nipple out. They are commonly known as nipple retractors, nipple extractors, shells and nipple cups. Over time, they help loosen the nipple tissue making the nipples remain erect longer. They may not be effective in some cases; however, they are an inexpensive form of treatment that can be done at home after seeking medical consultation. 
  2. Hoffman Technique
    This technique has been used to treat inverted nipples since 1950. It involves manual stimulation of the nipple. Similar to the “pinch test” mentioned above, you have to place your thumbs on either side of the base of your nipple. You then have to press firmly into your breast tissue and gently pull your thumbs away from each other while still pressing down. This technique has to be performed whenever you would want your nipples to protrude and is not considered a permanent solution to inverted or flat nipples.  
  3. Piercing
    Nipple piercing can be recommended to patients with inverted nipples. The Jewlery in the piercing is used to keep your nipple in an erect position. It is important to do your research before proceeding with piercing as you have to ensure that the piercer you choose is safe, hygienic and licensed. You also have to keep in mind the precautions to take post piercing to prevent infections in the piercing.  
  4. Surgery
    Aesthetic and reconstructive surgery offers a permanent solution to treat inverted or flat nipples. The surgery can be performed under local or general anaesthetic and typically takes about 2 hours. Your doctor might recommend either parachute flap technique (to preserve the milk ducts) or surgery with detached milk ducts.
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Prevention

In many cases, retracted or flat nipples can be a normal variation of nipple type and be present since birth. There are no specific steps you can take to prevent retracted or flat nipples. However, to avoid acquired retracted or flat nipples, you can take steps to prevent any underlying cause such as infection or duct ectasia from developing. These steps include maintaining good breast hygiene, wearing properly fitting clothes and avoiding unhealthy habits such as smoking.  

FAQs

1. Can I still breastfeed with retracted or flat nipples?

Inverted or flat nipples can make breastfeeding more difficult, especially for the baby to latch on properly. You can use breast shells about half an hour before breast feeding to draw out the nipple. However, milk collected while wearing breast shells should not be used or saved.  You can also use breast pumps to draw out your nipple immediately before breastfeeding.

2. How do I know when to see a doctor for inverted or flat nipples?

Typically, nipple inversion is considered a normal condition if it occurs gradually over time, is present since birth or is associated with pregnancy, breastfeeding or surgery. Seek medical advice as soon as you notice any additional symptoms such as discharge from the nipple (not when you are breastfeeding), lumps or if you develop flat/inverted nipples suddenly.  

3. Are inverted nipples permanent?

In certain cases, inverted nipples can correct themselves on their own. This is especially true when women develop this condition during pregnancy. However, in some women, this condition can become permanent or fluctuate between inverted and erect states.  

4. How long does inverted nipple surgery take to heal?

It takes approximately two to three weeks to see the results of an inverted nipple surgery. The sensation typically returns gradually over the course of five to six weeks. It is usual to experience some post-op swelling however if the swelling persists visit your doctor right away. 

 
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