Inverted and flat nipples are relatively common. There are different degrees of nipple inversion. Some nipples are inverted all the time but some can be encouraged to poke out (and may do so in the cold or with nipple stimulation). Inverted nipples can lead to difficulties with breast feeding and understandably some women just don't like the way they look.
Important warning: If one or both of your nipples has recently inverted you need to see your GP urgently as this could be a sign of breast cancer - this is what is affecting the breast in the photo on the right. Your GP will examine your breasts and likely order further investigations (mammography and ultrasound) and referral to a breast surgeon.
Can nipple inversion be treated without surgery?
Definitely! Many women don’t have to undergo surgery to correct their inverted nipples.
In many cases inverted nipples can be successfully treated with a discrete suction device that can be purchased from pharmacies or online without prescription. The Avent Niplette was developed by a UK plastic surgeon and is extremely successful at treating flat and inverted nipples. It can be purchased as a single or twin set (to treat one or two nipples). Click here to read the product information leaflet, which contains information on how to use the Niplette.
There are different severities of nipple inversion. Women who have nipples that are mildly retracted and that can be drawn out with mild pressure or stimulation will have greater success with the Niplette than those women whose nipples are severely retracted and which cannot be everted with mild or moderate traction.
The video below features a description and review of the Avent Niplette from a mother of two who used the Niplette to correct her nipple inversion to improve her ability to breast feed her second child.
Surgery is indicated for women in whom non-surgical therapies have failed. The type of surgery performed varies according to the severity of the nipple inversion. Wherever possible the milk ducts are left intact but in severe cases it may be necessary to cut the milk ducts to achieve nipple eversion. The milk ducts are only cut if you agree to this - and Dr Tomlinson has a policy of only cutting the ducts in women who have passed their childbearing years. There is a very thorough description of the surgical procedures that can be performed at the website of Dr Ramona Bates, an American plastic surgeon.
It is important to note that surgery will not address flat nipples that are not inverted. Some women have flat nipples that are naturally flat. If there is no "nubbin" of tissue to be everted then nipple eversion surgery will not give you more prominent nipples. Dr Tomlinson does not perform surgery on flat nipples and does not recommend that implants or fillers be used to try to give a boost to your nipple size. If you are very self conscious about your naturally flat nipples you may wish to try commercially available fake nipples (Google "fake nipples" to find an array of products).
What are the possible surgical complications?
Bruising, pain, sensitive scar, alteration in nipple sensitivity (including increased sensitivity once your nipples are no longer inverted), failure to correct the inversion and, rarely, injury to the blood supply of the nipple leading to nipple necrosis. The latter can occur if a very tight suture is placed circumferentially around the nipple.
Will I be able to breast feed after surgery?
It depends on the type of procedure and the recovery (including any scarring or infection) that you have. Not all women are able to breast feed, regardless of whether they have the surgery. The surgical technique that we most commonly use is one that preserves the milk ducts, so we do not anticipate that the surgery will prevent you from breast feeding, but we cannot promise that if you have surgical nipple inversion correction that will be able to breast feed.
What will it look like after?
The photos below show an inverted nipple (left, with purple texta marks from a surgical marker) and a surgically corrected result (right). The areolar incision that Dr Tomlinson performs the surgery through is approximately 1.5cm long and is placed below the nipple, so that a shadow cast by the nipple hides the incision. The amount of protrusion achieved by the surgery varies according to how severe your nipple inversion is. You can maximise the results of surgery by using a Niplette device after surgery to help to further stretch the milk ducts. This can also help to achieve symmetrical results if one of your nipples is much more inverted than the other.
Want to see more?
The UK television program "Embarrassing Bodies" featured surgical treatment of inverted nipples. The video below shows the surgical procedure being performed under local anaesthetic, and the post operative results at 8 weeks.
How much does surgery for inverted nipples cost?
The total out of pocket cost varies depending on where you have the surgery performed, what type of anaesthetic you have, whether you have private health insurance and whether your private health insurance covers all the costs of surgery, anaesthesia, and any hospital stay. The out of pocket fee for nipple inversion correction to both nipples as a rooms procedure with Dr Tomlinson is approximately $1800. Routinely we also recommend that you purchase a Niplette to assist in maximising the results of surgery - especially if you have severe nipple inversion.
To schedule an appointment to see Dr Tomlinson about nipple inversion correction surgery in Melbourne please phone (03) 9427-9596 or contact us via email.
Any surgical or invasive procedure carries risks.
Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.