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Inverted Nipple

An inverted nipple (occasionally invaginated nipple) is a condition where the nipple, instead of pointing outward, is retracted into the breast. In some cases, the nipple will be temporarily protruded if stimulated, but in others, the inversion remains regardless of stimulus.

The most common causes of nipple inversion include:

Born with condition
Breastfeeding
Trauma which can be caused by conditions such as fat necrosis, scars or it may be a result of   surgery
Breast Sagging, Drooping or Ptosis
Breast cancer including breast carcinoma, Paget's disease and Inflammatory Breast Cancer (IBC)
Breast infections or inflammations such as mammary duct ectasia, breast abscess or mastitis

Around 10-20% of all women are born with this condition.  Most common nipple variations that women are born with are caused by short ducts or a wide areola muscle sphincter.

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There are three "grades" of inversion - which basically means three levels of severity. While some nipples may only be inverted some of the time (and "come out" or become everted in response to cold or physical touch), others are more severely inverted and never come out. Some women can breastfeed normally, while others will never be able to breastfeed.
  •     Grade 1. Nipples are inverted but can become everted manually (through stimulation) or in response to cold temperature. They can remain everted for some time. Milk ducts are usually not compromised and breast feeding is possible. These are "shy nipples".
  •     Grade 2. Nipples are inverted and are more difficult to evert. The eversion almost never lasts - the nipple returns to the inverted state immediately. Breast feeding could be possible, but this is not a sure thing.
  •     Grade 3. Nipples are severely inverted and never evert. Milk ducts are often constricted and breast feeding is impossible. Women with Grade 3 inverted nipples may also struggle with infections, rashes, or problems with nipple hygiene.
Correction for inverted nipples can be done on an out-patient basis in local anesthesia.

The surgery consists of a small incision at the base of the nipple while the nipple is in a protected projected state. Then a gentle spreading of the fibers is performed within the nipple (these fibers are what pulls the nipple inward). Special care is taken: the spreading happens parallel to the milk ducts in order to preserve them. Once the fibers are spread and the nipple is free and in an outward, normal position, special sutures (stitches) are placed inside the nipple. This adds stability and strength to the base of the nipple and helps retain its outward projection. 
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