Nipple Inversion and Retraction

Introduction:

A retracted nipple turns inward towards the nipple instead of outward. Most people with inverted nipples have them at birth, which is harmless. However, if both or any one of the nipples invert abruptly, then it is a sign of some medical condition and requires attention. Some experts make some difference between inverted and retracted nipples, where a retracted nipple lies flat rather than getting inverted towards the breast.

What Is Meant by an Inverted Nipple?

Inverted nipples point inward toward the breast; sometimes, the inverted nipple is meant as retracted nipples. The retracted nipple lies flat on the breast, where the pigmented skin surrounding the nipple is present, known as the areola. An inverted or retracted nipple may be present in one or both breasts. In addition, the nipple may be flat or slightly inward or drawn deep into the breast, where they can be pulled out without surgery.

How Is Nipple Inversion Classified?

There is a grading system to classify the extent of nipple inversion. These are:

• Grade I:

The nipple can be pulled out using fingers, which stay in this position for a few minutes and gradually move inward or turn flat on the breast.

• Grade II:

The inverted nipple can be pulled out using fingers, but they move inward into the breast as soon as they feel free. Most of the people with inverted or retracted nipples are of this grade.

• Grade III:

The nipple is so inverted into the breast that it cannot be pulled out using fingers.

What Is Meant by the Nipple Being Inverted?

An inverted nipple, present from birth, is harmless and occurs suddenly due to some underlying condition that requires medical attention. Nipple inversion is not harmful unless it occurs suddenly, which may be a sign of an infection, injury, or any other issue that must be consulted with the doctor.

How Does the Inverted Nipple Affect?

• Cisgender women who are near their menopause can experience inverted nipples. Beginning their 30s to menopause, cisgender women can get inverted nipples as their milk ducts shorten and widen.

• Breastfeeding women are more likely to get inverted nipples as their mammary ducts get injured during breastfeeding.

• Women who smoke tobacco products are more likely to get breast infections, resulting in inverted nipples.

What Are the Causes of Inverted/ Retracted Nipples?

There are many reasons for the cause of inverted nipples. However, the cause for the inversion of the nipple should be ruled out, as some causes are harmless while others require medical attention. Some common causes are:

• Breast Injuries:

Trauma from surgery or injury caused by breastfeeding can alter the tissues in the milk duct, where the nipples get pulled inward.

• Scarring:

The milk ducts can be scarred due to breastfeeding, which results in the inversion of nipples.

• Complication:

A complication of breast reduction, where the milk ducts below the nipples can result in inflammation post surgery which causes inversion of the nipple.

• Infection and Inflammation:

The mammary duct can get infected due to clogging, and these alterations result in nipple inversion. Any woman can experience these changes, but women in their perimenopausal period are at higher risk. These changes may occur even after menopause too.

• Mammary Duct Ectasia:

One or more ducts under the nipples get clogged and may get infected, resulting in the inversion of nipples toward the breast.

• Bacteria:

Bacteria enter the breast through ducts or any crack in the nipple, which results in infection, which causes nipple inversion.

• Abscess Beneath Areola:

Pus accumulates beneath the areola, which causes infection resulting in nipple inversion.

• Breast Cancer:

An inverted nipple can be a sign of breast cancer.

• A tumor attacks the duct behind the nipple, which causes inversion of the nipple.

• Paget's disease, where cancer cells attack the nipples resulting in inversion of the nipple.

What Are the Symptoms of This Condition?

The signs and symptoms depend on the underlying cause of nipple inversion.

• Signs and Symptoms of Inflammation and Infection May Include:

  • Breast that is warm and tender to the touch.

  • Redness in the nipple region.

  • A lump beneath the nipple.

  • Bloody discharge from the nipple.

  • Discharge from the nipple, which is white, green, or black.

• Signs and Symptoms of Cancer May Include:

  • A lump in the breast.

  • Pain in the breast.

  • Swelling in the nipples.

  • Discharge from nipples.

  • Alterations in the skin include dimpling, itchiness, and flaky or scaly skin.

How Is This Condition Diagnosed?

The doctor will physically examine the breast, looking closely at the areola and nipple region. The procedure and tests to be followed will be based on what condition the doctor rules out during breast examination and the symptoms. Some common procedures used during the diagnosis of the inverted nipple are:

• Mammogram.

• Breast ultrasound.

• Breast MRI (magnetic resonance imaging).

• Needle biopsy.

How Is This Condition Treated?

The treatment will be based on the underlying cause of nipple inversion.

• The doctor will recommend antibiotics to treat the infection. In case of an abscess, the doctor will drain it or remove it through surgery.

• The treatment will be based on how advanced the cancer is. The doctor may recommend the following:

  • Hormone therapy.

  • Chemotherapy.

  • Radiation.

  • Surgery that eliminates the lump or the breast with an infected nipple.

• Cosmetic concerns, where the doctor may recommend surgery if the person is unhappy with how their nipple looks. An inverted nipple does not mean an unhealthy nipple. But if the nipple appearance makes the person feel so conscious, they can go with a cosmetic surgical procedure.

When to Visit a Doctor?

Retracted or inverted nipples that are present from the time of birth or which occur gradually over time are of no great concern. However, if an inversion of the nipple occurs suddenly, the person should consult a doctor, as it may be caused due to some underlying medical condition. Some other signs and symptoms of the nipple that needs medical attention are:

• Lump or swelling of the nipple.

• Pain or discomfort.

• Dimpling or thickening of the skin.

• Irritation, oozing, or redness.

• Nipple discharge.

Conclusion:

Retracted or inverted nipples are normal forms of nipple type. In this condition, the nipple appears inward towards the breast or may be flat on the breast. These conditions at birth or which occur gradually over time are of no great harm, but those that occur abruptly should be taken care of as they may be caused due to some underlying medical conditions. Treatment options include antibiotics in case of any nipple infection or surgery in case of severe nipple inversion. Cosmetic concerns can also be rectified through surgery.