Inverted nipples, which are retracted into the breast, are a malformation that can occur in either men or women. The causes of this condition can be different: some people are born this way, but others can develop inverted nipples due to an underlying condition. If you haven't had this problem since childhood or puberty, you should see a doctor - it may be purely cosmetic, but it could also have more serious consequences, such as difficulty breastfeeding. Fortunately, there are methods to solve the problem, from manual stimulation to plastic surgery.
Steps
Method 1 of 4: Make a Plan
Step 1. Determine the degree of inversion of the nipples
Take off your shirt and stand in front of a mirror. Grasp the breast at the edge of the areola (the dark area of skin surrounding the nipple) between the thumb and forefinger and press inward about 2.5 cm behind the nipple. Make a firm but gentle movement. Based on the reaction of the nipple, you can assess the degree of introflexion.
- Grade 1: The nipple easily protrudes when you apply gentle pressure to the areola. When you release the pressure, the nipple stays on the outside and doesn't immediately retract. At this level, introflexion hardly interferes with breastfeeding, although it is still an aesthetic problem. When the inverted nipples are first degree, fibrosis is minimal or absent (i.e. there is little excess connective tissue).
- Grade 2: The nipple protrudes when pressure is applied, although not very easily, and retracts as the pressure is released. At this level the problem creates some difficulties for breastfeeding. A moderate degree of fibrosis also often occurs, with a slight retraction of the milk-carrying ducts.
- Grade 3: the nipple is retracted and unresponsive to manipulation; in this case it is not possible to extract. This is the most severe form of inversion, with a significant amount of fibrosis and retracted milk ducts. In addition, skin rashes, infections can occur and breastfeeding can be impossible.
- Analyze both nipples, as they are not always both inverted.
Step 2. Identify the causes
If you've had this disorder since childhood or puberty, it shouldn't be an indicator of underlying problems. If it is a recent change, especially over the age of 50, it could be a symptom of a disease or infection. Cancer and other serious diseases such as inflammation and infections can sometimes be responsible for the introflexion.
- Over the age of 50: If the areola appears distorted while the nipple appears more flattened than normal or has become inverted, get tested for breast cancer immediately.
- Women over 50 are at risk of developing Paget's disease of the breast;
- Other symptoms of breast cancer are pink fluid discharge, crusting, thickening and flaking of the skin around the nipple;
- See your doctor if you have dark or greenish nipple discharge. Tenderness, redness, or thickening of the skin around the nipple can be a sign of ectasia of the mammary ducts.
- Perimenopausal women are more prone to ectasia of the mammary ducts;
- If a painful lump develops from which pus is leaking and you have a fever, it could be an infection called a subareolar abscess.
- Many nipple infections occur during breastfeeding, but subaerolar abscess occurs in women who are not breastfeeding;
- If you have recently had a nipple piercing and it has become inverted, ask your doctor to check for a subareolar abscess.
Step 3. Establish a treatment method
This mainly depends on the degree of introversion and whether you plan to breastfeed.
- If the inflection is first degree, then probably a simple manual stimulation could help loosen the fibrous tissue and allow the nipple to stretch more easily.
- If the problem is second or third degree, it may be advisable to consult a doctor to define a therapy. In some cases, non-invasive methods may be insufficient and plastic surgery may be the best choice.
- If you are pregnant or breastfeeding, ask your doctor or nurse to instruct you on how to proceed to feed the baby.
Method 2 of 4: Implement Handling Techniques
Step 1. Use the Hoffman technique
Place both thumbs on opposite sides of the nipple base and gently pull them in opposite directions. Do this exercise vertically and horizontally to the nipple.
- Start with two repetitions a day, gradually increasing to five.
- This technique aims to break the adhesions present at the base of the nipple that keep it inward.
Step 2. Apply manual or oral stimulation during sex
Twisting, pulling and sucking the nipple are all methods that have some use in trying to make it protrude. But make sure you don't force yourself to the point of pain; remember to be gentle, but firm.
Step 3. Rotate the nipple between the thumb and forefinger several times a day
Gently pull it when it is erect to stimulate it to stay that way.
Method 3 of 4: Use Specific Products
Step 1. Use the breast shells
You can easily find these devices at specialist maternity stores and online. These are protective and soft shells for the breast, they have a disc shape with a small hole in the center that pushes the nipple forward.
- Insert the breast inside the shell and position the nipple so that it comes out through the small hole.
- Wear this device under your shirt, undershirt and bra. You may need to have an extra layer of clothing to hide it properly.
- If you are preparing to breastfeed, keep it worn for 30 minutes before feeding the baby.
- The shell applies gentle pressure on the nipple and forces it to remain erect. It can be used by both men and women to treat nipple inversion.
- The shell can also stimulate breastfeeding in new mothers. Keep in mind, however, that the device should not be worn constantly for days on end if you are breastfeeding your baby. If you keep it when breastfeeding, be sure to wash it in warm, soapy water when you're done, and discard any leaking milk left in the clamshell.
- Check the area around your breasts when using the clamshell, as this device may cause a rash.
Step 2. Use a breast pump
If you are pregnant or breastfeeding, the breast pump allows you to extend the nipple tissue.
- Place the breast pump flange over the breast, making sure the nipple is centered over the hole. These tools come in different sizes, so find a model that fits your measurements and covers your nipple properly.
- Keep the flange against the breast, snug against the skin.
- Grab the flange or container in one hand and turn on the pump.
- Activate the pump at the maximum power you can handle without feeling discomfort or pain.
- Turn off the pump on the appliance with one hand while holding the milk container against your body with the other arm.
- If you have to breastfeed, offer the nipple to the baby once it is erect.
- Do not use the pump too much if you are breastfeeding your baby, or you will start drawing milk from the nipple.
- You can find a large variety of breast pumps on the market; those with the high quality electric pump, such as those used in maternity wards, are best for extending the nipple outside without damaging the surrounding tissue.
- Breast pumps vary by brand and model. Talk to a nurse or midwife to find out the best way to use the device you purchased.
Step 3. Use an inverted syringe
You can stretch the nipple outwards using a 10ml syringe without a needle (this size may vary depending on the size of your nipple).
- Take clean, sharp scissors to cut the end of the syringe where it reads "0ml" (the side opposite the plunger).
- Pull out the plunger and insert it back into the end you just cut, pushing it all the way down.
- Place the uncut end over the nipple and pull the plunger out so the nipple is sucked out.
- Don't pull too hard, but only as long as you feel comfortable.
- Before removing the syringe, push the plunger slightly to stop aspiration.
- Once finished, disassemble the various components and wash them with warm soapy water.
- If you prefer, you can find a medical device called Evert-It on the market; it is basically a modified syringe with a breast flange and works according to the same principle just described. In Italy it is not yet widespread in stores, but you can buy it online.
Step 4. Use the Niplette
This device allows you to stretch the milk ducts by pulling the nipple for an extended period. This is a small, clear plastic tool that needs to be placed over the nipple and under clothing.
- Apply a small amount of specific ointment to the nipple, areola and base of the Niplette.
- Insert the syringe into the open end of the valve, pushing firmly.
- Place the Niplette over the nipple with one hand and pull the syringe with the other to create a sucking force. Don't pull too hard, it doesn't have to be painful!
- Once the nipple has been pulled out, loosen the Niplette.
- Grasp the valve and carefully remove the syringe from the valve. Proceed gently to avoid air being injected and pushed in, as this will cause the device to fall.
- Put the Niplette under your clothes. If you are wearing a tight top, you can hide the device using a specific cover designed specifically for this purpose.
- When you remove the Niplette, push the syringe into the valve to break the vacuum.
- In the beginning, you should wear the device for an hour a day. You can gradually increase it by one hour every day, as long as you can wear it for 8 hours.
- Don't keep it night and day!
- Within three weeks you should start to see results and the nipple should be able to fill the Niplette cup.
Method 4 of 4: Undergo Medical Treatments
Step 1. Talk to your doctor or plastic surgeon for advice on corrective surgery
Even if you would like to solve the problem with non-surgical techniques at all costs, for some people and in certain circumstances the operating room is the best solution. The most recent procedures allow you to intervene without cutting the milk ducts, so you can continue to breastfeed even after the surgery. Your doctor or plastic surgeon will be able to determine if you are a good candidate for this type of surgery.
- The surgery consists of a short day hospital procedure that involves the use of local anesthesia. Sometimes it is possible to go home the same day and, as it is minimally invasive, you will probably be able to return to your normal activities (work, etc.) as early as the following day.
- Review the procedure with your surgeon. Know how the surgery is performed and what results you can expect.
- At this point the surgeon will review your medical history and assess the cause of your problem.
Step 2. Follow the pre- and post-operative instructions carefully
The surgeon will give you directions on how to prepare for the surgery and what you need to do next.
After the operation, you will probably need to dress the nipple and change the gauze as directed by the surgeon
Step 3. Once the operation is complete, ask the doctor any questions or concerns you have
To make sure you heal well and perfectly, it is extremely important to contact your surgeon when any unforeseen discomfort or problem occurs.
Step 4. Schedule a post-operative visit with your doctor
This meeting is intended to evaluate the progress of healing and the success of the procedure.
