Inverted Nipples – Are innies anything to be concerned about?
By Robin Roberts
When Carol Bueller became pregnant with her first child, like all new parents-to-be, she prepared for her bundle of joy by decorating a baby’s room and reading all about what to expect now that she was expecting. What she didn’t expect or prepare for was the possibility she would not be able to perform the most basic maternal function: breastfeeding.
To her surprise, as Bueller’s pregnancy progressed and her breasts enlarged, her nipples shrunk. In fact, they retreated so much they became completely inverted. “I panicked,” recalls the Vancouver mom. “I worried about how the baby was going to feed.” Her fears were founded: her newborn daughter struggled to latch on to her breast. The more the baby tried the more pain and discomfort Bueller endured, until both of them were in tears. Distraught, she thought there was something seriously wrong with her, until she discovered that her mother also suffered through inverted nipples (so badly they became abscessed), as did her aunt and her cousin.
If four women from the same family experienced the same problem, how common are inverted nipples? Quite, actually. “Quoted figures vary considerably, but they range somewhere from 10 percent up to 30 percent overall — not just pregnant women — who have some form of inverted nipples,” says Dr. Lawrence Tong, who corrects the condition out of his Toronto-area practice, Yorkville Institute of Plastic Surgery. “There’s anecdotal evidence that it’s hereditary because we’ve had patients tell us their mother or grandmother had the same issue, but I don’t think there are any studies to verify that.”
Dr. Tong says the condition can also be congenital, and not manifest until puberty or pregnancy, when the breasts grow but the ducts don’t, or at least don’t at the same rate. Instead of becoming erect when stimulated or cold, inverted nipples sink into the breast. You can check if you have them by gently squeezing the areola about an inch behind the nipple with your thumb and index finger. If the nipple dimples or indents, it’s inverted. (Note: If you are not pregnant and your nipple suddenly indents, see your doctor to rule out anything more serious, such as breast cancer.)
Inverted nipples are caused by short ducts, the pipes that carry breast milk to the outside. The most common — and successful — surgery severs those ducts completely, meaning no pipeline for milk. “There are other procedures that attempt to spare the ducts,” says Dr. Tong, “but the trade-off is that the degree of correction, meaning how much the nipple sticks out, might not be as improved.” For this reason, the vast majority of inverted nipple corrections are done solely for esthetic reasons, because many women feel embarrassed by their innies.
A relatively simple procedure, the surgery, says Dr. Tong, takes less than two hours, on an out-patient basis, usually under local anesthesia at a cost of between $3,000 and $4,000. The incision cuts along the base of the nipple, releasing the milk ducts so they no longer pull the nipple inward, and leaves a near-invisible scar. Recovery takes about a week with anywhere from two to four follow-ups to ensure all is well.
But for many pregnant or nursing women with inverted or flat nipples, the situation is not a complete bust: If only one nipple is inverted and the other is in working condition, you can quite easily feed entirely from one breast. Or, if you have a determined baby on your hands, you may very well have no problem at all. “The ability to breastfeed is not necessarily dependent on having a nipple that is protruding,” says Dr. Tong, since the baby feeds from the whole breast, not just the nipple. And if she can get a mouthful, she can successfully feed.
Many mothers utilize the Hoffman Technique, which involves gently rolling the nipple with their fingers before feeding, or using a breast pump to stretch or loosen the tissue. There are also devices, such as a nipple shield, which Carol Bueller ultimately used, available at most pharmacies or medical supply stores. Made of soft silicone material with holes at the tip to allow the milk to flow through, the shield is worn over the breast during nursing. Suction inside the shield helps extend the nipple, which allows the baby to pause without losing his grip.
Jeanne Hagreen, co-president of the B.C. branch of the Canadian Lactation Consultant Association, says, “I saw a woman who had quite indented nipples and she successfully breastfed three children, and they did not pop out much. But the breasts will still produce milk, and babies smell milk and will instinctively seek it out.” Hagreen, who assists new mothers or those with difficulty breastfeeding, also has seen success with express pumps or by rolling the nipples.
And, according to Dr. Tong, pregnancy itself will sometimes pop out the nips. “[In some cases] nipple inversion can be improved to some extent after becoming pregnant and, if a patient is able to breastfeed a little bit the first time despite nipple inversion, there’s usually a fairly good chance that she’ll still be able to breastfeed afterwards with no intervention.”
So between the very real possibility you’ll still be able to nurse, and having the optionof nipple correction surgery if you simply want to be, um, more outgoing, flat or inverted nipples are no reason to feel like a boob.