Nipple inversion — where one or both nipples are retracted inward rather than projecting outward — is a common condition that affects a meaningful proportion of women and, less commonly, men.

For many people it is a longstanding feature of their anatomy that causes no concern. For others it can cause practical difficulties, cosmetic distress, or — when it develops newly in an adult — indicate an underlying condition that warrants assessment.

At Breast & Surgical Oncology at The Poche Centre, nipple inversion is assessed and managed as part of our specialist breast practice. We can determine whether your nipple inversion requires investigation, and where surgical correction is appropriate, we offer an effective procedure with a natural and lasting result.

Types of Nipple Inversion

Nipple inversion is graded by severity, which reflects both the degree of retraction and whether the nipple can be manually everted.

Grade 1 — the nipple is inverted but can be easily pulled out and maintains its projection for a period before retracting again. The underlying ducts are not significantly shortened or fibrosed.

Grade 2 — the nipple can be everted with manual pressure but does not maintain its projection without assistance. The ducts are more significantly tethered.

Grade 3 — the nipple is deeply and permanently inverted and cannot be manually everted. The underlying ducts are fibrosed and contracted. This grade typically requires surgical intervention to achieve lasting correction.

Causes of Nipple Inversion

Developmental (congenital) nipple inversion is the most common cause and is present from puberty. It typically affects both nipples and is caused by shortened or fibrosed milk ducts that tether the nipple inward rather than allowing it to project. Developmental nipple inversion is entirely benign and carries no increased risk of breast cancer.

Periductal mastitis and duct ectasia — chronic inflammation and scarring of the ducts beneath the nipple can cause progressive nipple inversion over time, often accompanied by nipple discharge or recurrent subareolar infection. This is the most common cause of acquired nipple inversion in adult women and is frequently associated with cigarette smoking.

Breastfeeding — some women develop nipple inversion or worsening retraction following breastfeeding, related to changes in duct and ligament anatomy.

New or worsening nipple inversion in an adult — any nipple that was previously normal and has become retracted, or an existing inversion that has worsened over a short period, requires specialist assessment to exclude an underlying breast cancer, which can tether the nipple through involvement of the subareolar ducts or Cooper's ligaments. New nipple inversion is a symptom that should never be dismissed without proper evaluation.

When to Seek Assessment

Longstanding bilateral nipple inversion that has been present since puberty and is not changing does not generally require specialist assessment unless it is causing a practical problem or cosmetic concern.

You should seek assessment if your nipple inversion is new or has recently worsened; if it affects one nipple only and developed in adulthood; if it is accompanied by nipple discharge, skin changes, or a palpable lump; or if you are considering surgical correction and would like specialist guidance.

Surgical Correction of Nipple Inversion

Surgical correction of nipple inversion is an effective procedure that produces a lasting improvement in nipple projection and appearance. It is most commonly performed for grade 2 and grade 3 inversion, where manual eversion alone is not sufficient to maintain projection.

The procedure is performed under local anaesthetic as a day procedure, often without the need for a general anaesthetic. A small incision is made at the base of the nipple, and the fibrosed or shortened ductal tethers pulling the nipple inward are carefully divided to release the retraction. The nipple is then supported in its everted position using fine sutures placed through the base of the nipple, a supporting suture technique, or a small implanted suture that maintains the correction as healing occurs.

The most important consideration in the surgical technique is whether the patient wishes to preserve the ability to breastfeed. Fully dividing the ducts to achieve complete release of the inversion will prevent breastfeeding from the operated nipple. For women who have not yet completed their family and wish to preserve the option of breastfeeding, a more conservative release that avoids complete duct division can be performed, though this carries a higher rate of recurrence of the inversion. This trade-off is discussed at consultation and the approach is tailored to the patient's priorities.

Recovery is quick and straightforward. Most patients experience mild tenderness for a few days. The nipple is supported with a small dressing for several weeks while healing occurs. Scarring is minimal as incisions are small and placed at the natural base of the nipple.

A Note on New Nipple Inversion

It is worth reiterating clearly: new nipple inversion in an adult that was not present before is a breast symptom that requires proper specialist assessment before any discussion of surgical correction. Your surgeon will ensure that an underlying cause has been appropriately excluded with clinical examination and imaging before any procedure is planned.

Booking an Appointment

If you have concerns about nipple inversion, whether for assessment, investigation of a new change, or to discuss surgical correction, we welcome a consultation.

This page is intended as a general guide only and does not replace personalised medical advice. Any new change to the nipple should be assessed by a specialist before considering surgical correction.