Inverted Nipple Correction

Surgical correction releases the tethering tissue beneath the nipple to allow it to project, with the specific technique depending on the grade of inversion and what’s caused it.

Inverted nipple correction is one of the smaller breast operations Dr Shepherd performs, and is often done as a day procedure under either local or general anaesthesia. Despite the smaller scale of the operation, the decisions involved (particularly around whether to preserve or divide the milk ducts) have implications that deserve careful thought before surgery.

Congenital nipple inversion is the most common cause, and is usually due to short or tight milk ducts and connective tissue beneath the nipple that tether it inward. Congenital inversion has typically been present for as long as the patient remembers, sometimes becoming more or less prominent at different stages of life but with the underlying tendency to inversion always there.

Acquired nipple inversion has a longer list of possible causes, including breastfeeding (where ducts can become scarred or shortened), infection in the breast tissue or duct system, trauma, previous breast surgery, or in some cases changes in the breast tissue related to other underlying conditions. New onset inversion in an adult who hasn’t had inversion before is a different situation to long-standing inversion and should always be assessed by a doctor before any cosmetic correction is considered. In some cases, new onset inversion can be a sign of an underlying breast condition that needs investigation, including in rare cases findings related to breast cancer. We strongly recommend a discussion with your GP and appropriate breast imaging before any cosmetic correction of new-onset inversion is planned.

Nipple inversion is graded according to severity, using a scale that affects both the surgical approach and the implications for breastfeeding:

The procedure involves a small incision at the base of the nipple, releasing the tethering tissue (which may include connective tissue bands and shortened milk ducts), and using internal sutures to maintain the new nipple projection. In some cases, particularly in higher grades of inversion, the milk ducts beneath the nipple have to be divided to allow the nipple to project. Dividing the ducts produces reliable correction of the inversion but means that breastfeeding from the affected side won’t be possible afterwards.

For more severe cases, small additional incisions may also be made in the areola so that tissue can be passed under the nipple to build a kind of internal support. This helps prevent the nipple from retracting back inward as the tissues heal, and is used selectively in higher grades of inversion where simple release alone isn’t likely to produce a durable result.

In lower grades, duct preservation is often possible and the technique is designed to release the tethering connective tissue while leaving the ducts intact. This means breastfeeding may still be possible after surgery, although it can’t be guaranteed. The trade-off between duct preservation and reliable correction of inversion is part of the conversation we have at consultation, particularly for younger patients who may want to breastfeed in the future.

Surgery is performed under either local anaesthesia or general anaesthesia depending on the situation, the grade of inversion, and patient preference. It can be done as a day procedure, with most patients going home the same day. The operation usually takes 30 to 60 minutes per side.

Dressings or splints may be applied to the nipple to maintain projection in the early healing phase, and these are reviewed at follow-up appointments through the first few weeks. Sutures are typically removed or settle within one to two weeks, depending on the suture material used.

Most patients describe mild discomfort that settles within a few days. The nipple may be tender for a couple of weeks, particularly when bumped or pressed. Most patients return to normal daily activity within a few days of surgery, with restrictions on activities that put pressure or friction on the nipple (such as certain sports or particular bra styles) applying for several weeks while the surgical site heals.

Where the milk ducts can be preserved during surgery, the ability to breastfeed may be retained, although breastfeeding ability after any surgical procedure on the nipple can’t be guaranteed. Where the ducts have to be divided to achieve correction, breastfeeding from the affected side won’t be possible after the operation.

This is an important conversation before surgery, particularly for women who may want to breastfeed in the future. The grade of inversion influences how feasible duct preservation is, with lower grades more amenable to duct-preserving techniques and higher grades sometimes requiring duct division to achieve reliable correction. For patients who place a high value on preserving the option to breastfeed, sometimes the right decision is to defer surgery, accept a less complete correction with a duct-preserving technique, or simply live with the inversion. We work through these options at consultation.

The known risks include:

Dr Henry Shepherd, BMed MD MS (Plast.) FRACS (Plast.) | Specialist Plastic Surgeon | AHPRA registration: MED 0001860545