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Do inverted nipples require treatment?

Inverted nipples indent more than they protrude. They can occur on one or both breasts. It’s estimated that 9 to 10 percent of women have at least one inverted nipple. Men can have them, too.

Some nipples only invert sometimes, and can reverse after changes in temperature or stimulation. Others nipples can be permanently inverted. This means that they’ll remain inverted unless you try to reverse them through one of the methods described below.

In most cases, having an inverted nipple won’t affect you. This natural occurrence doesn’t increase your risk for any health complications. And it shouldn’t affect your nipple sensitivity.

If you want to reverse an inverted nipple for aesthetic reasons, keep reading.

If you’re looking for a temporary solution, you may want to consider:

Hoffman technique

The Hoffman technique for drawing out inverted nipples has been in use since the 1950s. To try it:

  • Place your thumbs on either side of your nipple. Be sure to place them at the base of the nipple, not the outside of the areola.
  • Press firmly into your breast tissue.
  • While still pressing down, gently pull your thumbs away from each other.
  • Move your thumbs all around the nipple and repeat.

You can do this whenever you’d like for your nipples to protrude, but it isn’t clear how long this effect will last. For best results, practice this technique at least once a day. Regular stimulation may help your nipples protrude more often.

There haven’t been any studies proving whether it’s effective. Everyone’s breasts are different, so try not to get discouraged if this method doesn’t work for you.

Suction devices

There are some suction devices promoted for reversing inverted nipples. Most are worn under clothing for extended periods of time.

These products are sold under a variety of names, including:

  • nipple retractors
  • nipple extractors
  • shells
  • cups

These devices usually work by pulling the nipple into a small cup. This stimulates the nipple and makes it protrude.

When used over time, these devices can help loosen the nipple tissue. This can help your nipples remain erect for longer periods of time.

Popular options include:

There hasn’t been any research on the effectiveness of suction devices. Some people may experience nipple protrusion and others may not. Most devices are inexpensive and may be worth a try.

Nipple piercing is sometimes done to draw out inverted nipples. This is because jewelry worn in the piercing can help keep your nipple in an erect position.

If you’re interested in getting your nipples pierced, do your research. You’ll want to be sure any piercer you choose has a license and experience piercing inverted nipples. Your best bet is to call piercing parlors in your area and let them know what you’re looking for.

What’s the procedure like?

At your appointment, remind your piercer that you have inverted nipples. They’ll likely want to make the room colder to help draw out the nipple. Your piercer may also use nipple clamps to help pull the nipple out.

During this time, your nipples may turn red or feel achy. In most cases, this happens because the nipple is being forced out. This may also make the actual piercing more painful.

It’s important that your nipples are completely drawn out before piercing. If they aren’t, your nipples may invert even after the jewelry is in place.

Once your nipples are completely out, your piercer will use a gauged needle to thread a piece of jewelry through the nipple.

Often, the jewelry used is a stainless steel ring or a barbell. A barbell is held in place with screw-in balls on both ends. This prevents the nipple from sinking back into the breast. You should keep the ring in place for four to six months before switching jewelry.

Men are typically pierced with a 14-gauge needle, and women are typically pierced with a smaller 16-gauge needle. This can vary from person to person, though. Be sure to talk with your piercer about the right size for you.

Not everyone finds piercing effective. It’s important that you weigh your options before getting pierced. Talk to your doctor and potential piercer about the benefits and risks.

If you do decide to get your nipples pierced, note that taking the jewelry out may cause your nipples to invert. To prevent this, avoid leaving the jewelry out for extended periods of time.

Check out: How to recognize and treat a nipple piercing infection »

If you’re looking for something permanent, your only option is surgery.

There are two different types of surgeries: surgery that preserves the milk ducts and surgery that doesn’t.

Surgery with partial preservation of milk ducts

This is also known as the “parachute flap” technique. Women undergoing this procedure should still be able to breastfeed because some of the milk duct system remains attached. You shouldn’t experience a change in nipple sensation.

Here’s how it works:

  • After applying local anesthesia, your doctor will make an incision around the base of your nipple.
  • While still attached, the nipple and areola are both lifted from the breast and sewn into a protruding shape.
  • Your doctor will then close the incision and apply medicated gauze.

Surgery with detached milk ducts

This procedure is more common. Women undergoing this procedure won’t be able to breastfeed because of the removal of the milk ducts. You shouldn’t experience a change in nipple sensation.

Here’s how it works:

  • Your doctor will apply local anesthesia before making an incision at the base of the nipple.
  • Your milk ducts are then detached. This will allow the nipple to protrude.
  • Your doctor will then close the incision and apply medicated gauze.

Each surgical option typically takes one to two hours. You should be able to return home within a few hours of the surgery.

Talk to your doctor about which option is right for you.

There are three grades of inverted nipples. The grades determine or describe:

  • the degree of inversion
  • the likely effect of the inversion on breastfeeding
  • the best solution if you want the inversion altered

Grade 1: Placing your thumb and index finger on the areola and pushing or squeezing gently can pull out the nipple. The nipple will often stay out for some period of time. Stimulation or breastfeeding can also draw the nipple out.

Grade 2: This grade means it may be more difficult to pull out the nipple than a grade 1 inversion. When released, the nipple retracts inward.

Grade 3: It’s difficult or impossible to pull the inverted nipple out.

Both the Hoffman technique and suction cups may be more successful for people with grade 1 or 2 inversion. Surgery can typically remove any grade of inversion.

How to determine your grade of nipple inversion

Many people know that they have inverted nipples, but aren’t clear on how inverted their nipples are.

Here’s how to figure it out:

  1. Take off your shirt and any undergarments you have on.
  2. While standing in front of a mirror, hold the areola on each breast between your thumb and forefinger.
  3. Gently press inward. You should firmly press about an inch or so into the breast.
  4. Take note of how your nipples respond and use this to assess their grade.

You may only experience inversion in one nipple, or even different grades of inversion in each nipple.

Learn more: 13 common breastfeeding problems and how to fix them »

For some women, inverted nipples can make breastfeeding more difficult. Some women find that their baby has a hard time latching onto the nipple to feed. This may be because, due to inversion, the nipple doesn’t become erect.

If you plan to become pregnant or are already breastfeeding, talk with your doctor.

There are some techniques that you can use to help bring the nipple out, including:

  • nipple shields to help the baby latch on
  • breast shields to apply pressure to the nipple, helping it protrude
  • manual nipple stimulation with your hands

You may also find that milk flows better when using a breast pump.

The only difference between inverted and erect nipples is in the contract nerves — not the sensory nerves. Inverted nipples can experience the same sensations as erect nipples. Nipple sensitivity can also vary from person to person.

You may find that you feel more, or less sensation depending on the situation. For example, you may feel more sensation during manual stimulation than when the nipple brushes against the fabric of your bra or shirt.

Some people may only experience inversion some of the time, and others will experience inversion all the time. Others may find that nipples that once seemed permanently inverted now fluctuate between inverted and erect.

Many women experience inverted nipples during pregnancy, even if their nipples weren’t inverted before becoming pregnant. This is especially true of women who are pregnant for the first time.

Nipple inversion is one of several common breast variations. It shouldn’t have any effect on your health.

Often inversion can be temporarily adjusted through manual stimulation. If you’d prefer something more permanent, talk to your doctor about nipple piercing and options for surgery. They can walk you through the potential benefits and risks of each option.

Women who are breastfeeding, or women who may want to breastfeed, should take this into consideration when exploring piercing or surgical options. Piercing may inhibit your ability to breastfeed, and certain surgeries can prevent you from producing milk.

Nipple inversion typically isn’t cause for concern if it:

  • has been present since childhood or puberty
  • happens gradually, over several years
  • is associated with pregnancy, breastfeeding, or surgery

If you develop inverted nipples for no known reason, see your doctor. In some rare cases, a nipple that begins to turn inward may be a sign of breast cancer. Breast cancer is more treatable when caught in the early stages.

Keep reading: Nipple problems »