Inverted Nipples

By Jerome Edelstein, MD

Everyone’s nipples and areolae (the dark tissue surrounding the nipple) are different, ranging in shape, colour and size. While each of us is born with a unique combination of these “normal” traits, our nipples still change throughout our lives as hormone levels shift during puberty, pregnancy and/or breastfeeding, as well as with age.

Some level of variation is to be expected, but it’s still important to monitor your nipples for unusual changes that can’t be attributed to natural causes. Coupling a monthly breast self-exam with a check for nipple abnormality will help you to watch out for the development of any issues that may require medical attention.

NIPPLE VARIATIONS”Normal” Nipples What we think of as a “normal” nipple appearance — elevated tissue located in the centre of the areola — is characterized as everted. Everted nipples are raised away from the breast’s skin at normal body temperature and do not require stimulation to maintain their elevation. They are kept erect due to a tiny cylindrical column of small smooth muscles and become more pronounced when affected by cold or touch. Everted nipples in women allow for easier breastfeeding.INVERTED NIPPLESNipple inversion is a common condition that affects many people. In cases of inversion the nipples look as if they’re indented (rather than protruding above the areola) due to overly tight breast ducts. The tension of these ducts draws the nipples inward and, in severe cases, can even lead to a visible surface depression at the areola’s centre. Inverted nipples may become erect with stimulation. They can be made more apparent with the cosmetic surgical procedure, inverted nipple correction.THE CAUSE OF INVERTED NIPPLESMany people are born with inverted nipples, but the condition can also develop on one or both breasts as the result of breast surgery (like breast reduction, lifts or cancer-related surgeries such as radiotherapy or lumpectomy) or pregnancy. By understanding which alterations are natural and which are not, every woman can more effectively monitor her own health during a monthly breast self-examination.

While inverted nipples are not a concern in and of themselves, their development should still be monitored. Some forms of cancer alter the breast ducts and can lead to duct — and ultimately nipple — retraction. Anyone who discovers nipple inversion during their self-examination is urged to bring the change to their physician’s attention in order to determine whether or not there is any cause for concern. Unusual changes (like lumps, pain, blisters or nipple discharge) should be professionally assessed by a medical doctor.