Type 3 inversion. Immediately at end of operation 6 weeks post-operation
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What is the cause of inverted nipples?
Inverted nipples are actually fairly common in women and also men. Many women feel that they are unable to admit to having inverted nipples. Also, inverted nipples do not always come in pairs as many women only have one. It s defined by a three-level grading system and the severity of the inverted nipples can vary considerably.
Common causes behind inverted nipples
Congenital - you may have simply been born with inverted nipples.
Breastfeeding – this can damage milk ducts and make them more fibrous and retract, pulling the nipple inwards.
Surgery – scar tissue from previous surgeries may cause inversion.
Breast drooping – common as women age and the skin around the nipple becomes looser.
Infection – this could cause inflammation and result in fibrous scar tissue pulling the nipple in.
It is mostly an imbalance between the inwards pulling of the milk ducts and the traction of the muscle within the nipple whose action normally pulls the nipple outwards.
If the inward tethering force of the tight, shortened milk ducts is greater than the force exerted by the muscle within the nipple, inverted nipples will result.
Conservative Non-surgical treatment versus surgical options
Before choosing to undergo correction via surgery, I advise you to consider treatments which can help your nipple inversion without surgery. I would always encourage you to explore them before thinking about surgery.
The Niplette suction device;
A pump which inserts gentle traction on your nipples and is generally used overnight as you sleep. The gentle traction slowly stretches your milk ducts allowing the nipple to sit in an everted position.
The Niplette suction device has the effect of gently stretching the milk ducts which are the main cause of your inverted nipples.
We have noticed that more patients with flat or grade 1 nipple inversion tend to respond well to the Niplette suction device but it does not work so well with grade 2 to 3 nipples.
If the Niplette suction device does not satisfactorily correct your nipples, the main alternative is surgical, which can be performed under general or even better is a local anaesthetic.
If the surgical procedure is performed under local anaesthetic, it is as a day patient and takes approximately 30 minutes for each inverted nipple correction.
The tight milk ducts which are tethering your nipple inwards are divided. This allows your nipple to come out and lie in its normal position. Soluble internal stitches are used at the base of the nipple to hold it in position whilst it is healing.
Breastfeeding and Nipple Correction surgery
The main downside of the procedure is that you will be unable to breastfeed after inverted nipple correction. This is because the milk ducts which carry the milk from the underlying breast glands to the nipple will be divided or lengthened during the operation. This is something you'll need to consider carefully if you are planning to have a family and would like to breastfeed. If you have grade 1 inversion the suction from the baby can bring the nipple out enough for them to feed. With grade 2 and 3, it still may be very difficult to breastfeed.
Grades of inverted nipples and correction required
Grade 1 inverted nipples:
It is characterised by being either flat or slightly inverted. They are those which are more commonly referred to as “shy” nipples. These can be coaxed out to protrude like a “normal” nipple by stimulation such as the cold or massage. This type of inversion is generally not associated with breastfeeding problems, as the milk ducts are minimally affected. It is not especially clear exactly what causes “shy” nipples are there is rarely fibrosis in the nipple and the milk duct is slightly short They stay out for a short period before returning to a flat or slightly inverted position.
Grade 1 inverted nipples can, in many cases, be treated with the Niplette suction device as the milk ducts are only slightly short in this case and in some instances can be lengthened adequately to provide correction of inverted nipples with suction and gentle stretching of the milk ducts.
Correction for Grade 1 inverted nipples
Surgery is appropriate in some cases of grade 1 nipple inversion if you are very concerned about the appearance of your nipples, however, it is important to consider that most people with Grade 1 inverted nipples can generally breastfeed and if you have surgery you will not be able to breastfeed following your inverted nipple correction procedure.
Grade 2 inverted nipples:
The inward pull of the milk ducts is stronger than in grade 1 inverted nipples. This produces nipple inversion which is normally deeper than in grade 1 and can give a horizontal line to the centre of the nipple. Your nipples may come out spontaneously or with suction for a short time, but will immediately resume their inverted position.
Correction for Grade 2 inverted nipples
Some grade 2 inverted nipples do correct with the Niplette suction device and you may be able to breastfeed if you do have grade 2 inverted nipples. However, if the treatment with the Niplette suction device does not adequately control your nipple inversion, then corrective surgery, by a division of the ducts, may be required to cure your inverted nipples.
Grade 3 inverted nipples:
There is a significant pull of the milk ducts that are tighter and shorter than the other grades. The outward pull of the muscles within the nipple cannot hold the nipple outwards and maintain that position.
Grade 3 inverted nipples rarely, if ever, evert. There are very distinctive features to the nipples including a transverse fold across the nipple and sometimes a central collection of tight milk ducts creating a more central puckering of the nipple.
Correction for Grade 3 inverted nipples
In grade 3 inverted nipples the milk ducts are very short and tight and it is unlikely that suction devices such as the Niplette will adequately cure your inverted nipples in this case. It is rare but some people with grade 3 inverted nipples will be able to breastfeed, but this is unlikely and surgery is usually the preferred option to correct grade 3 nipple inversion