The grading scale is from 1 to 3: 1 being the most mild inversion, 2 being moderate, and 3 being the most severe. Manipulation, stimulation, or temperature will usually allow a grade 1 inversion to evert on its own. For grade 2 cases, this is less likely, and for level 3 cases, the nipple remains fully inverted and drawn into the breast tissue despite any type of stimulation.
But what causes the nipple to become inverted in the first place?
The 411 on Inverted Nipples
We all have “tethering fibers to hold the nipple in position,” says Adam Kolker, MD, a board-certified plastic surgeon in New York City, but these fibers are tighter or shorter in people with inverted nipples. To enable the nipple to assume its natural, outward position, these tightened fibers have to be released, sometimes via surgery depending on the severity of the inversion.
“If someone has a grade 1, I will most commonly recommend a more conservative course of management,” says Dr. Kolker. This can include using a manual or electronic suction device to create a vacuum-like effect that pulls the nipple out over time, he explains. (These devices are also commonly used by lactating parents with inverted nipples to help an infant latch on.) Adds Dr. Kolker, “Anytime someone can treat anything to their satisfaction without surgery, I’ll always recommend it.”
Most inverted nipples are congenital, but it is important to note that if your nipples become inverted later in life, you should be evaluated for breast infection or other injuries. Says HerMD’s Dr. Miller, “Breast cancer should be on the radar, especially for patients in at-risk groups, including those with family history of breast cancer, post-menopausal, BRCA-mutation carriers, and previous history of breast cancer.”
I had grade 2 and grade 3 nipples — this type of asymmetry is fairly common — so, at age 25, I decided to meet with my first plastic surgeon about corrective treatment. “It’s one of those almost niche procedures that not a lot of people know about,” says Dr. Doft of inverted nipple correction.
But after having the surgery, which insurance does not cover because it is considered a cosmetic concern, my nipples reinverted six months later. This is also quite common, especially with grade 3 cases; according to Dr. Kolker, the likelihood of recurrence hovers around 50% (although there are fewer studies on what happens after multiple corrective surgeries). “Certain tissues in the body, like the nipple, have a coil effect,” he explains. “The collagen and elastin have a memory to them, so there’s always a possibility they want to go back to their native resting position.”