In this recurring guest column, Kate White, M.D., of Boston Medical Center, answers your questions on all things gynecology. As the author of the Mayo Clinic Press book “Your Sexual Health,” she’s ready to dole out wisdom on sex, periods, menopause and more. Submit a question here.
Q: Why do I have an inverted nipple and is that an indication of something else wrong? It doesn’t hurt.
A: Nipples are just one of the parts of the body that can show great variety. For most folks, their nipples are everted, meaning they point outward, away from the breast. But nipples can be:
- Flat
- Partially pulled in so the nipple looks like it has a slit
- Pointed all the way inside
Some people can pull an inverted nipple out(though it naturally pulls in again) and some people can’t.
Many people with inverted nipples were born that way. Fun fact: It’s estimated that perhaps up to 5% of cisgender women have inverted nipples at birth, and most of the time both of their nipples are inverted.
Nipples can pull into the breast over time, sometimes due to weight changes or after breast surgery.
Another cause of inverted nipples is breast inflammation. Breast tissue inflammation — sometimes including an infection — is known as mastitis. You’ve likely heard the term in connection with breastfeeding, in which case it’s called lactation mastitis. But mastitis can affect people who aren’t breastfeeding. You also can experience inflammation when one or more milk ducts beneath your nipple widens and fills with debris. This condition is called duct ectasia.
With mastitis, your breasts may be swollen, tender or warm to the touch, and you may have a fever. The breast may have red, brown or purple tones. With duct ectasia, you may have thickening near the clogged duct, or nipple discharge when you squeeze the nipple. In either case, infections are often treated with antibiotics. If the infection has progressed to an abscess, you may need to have the abscess drained. If there is a rash, color change, or persistent scaling or flaking of the skin involving the nipple or areolar area, a biopsy may be recommended to rule out a serious condition known as Paget’s disease.
While a nipple pulling in is quite common, it’s important to get a newly inverted nipple checked out. This can be a sign of a growth in the breast or even cancer. Other signs of cancer include a lump in your breast, skin dimpling, pulling in or peeling, or color change that does not go away after a course of antibiotics.
If cancer is a concern, your health care provider may send you for imaging, particularly a diagnostic mammogram or a focused ultrasound behind the dark areola of the nipple. This is called a subareolar ultrasound. You may end up needing a biopsy — either through ultrasound-guided imaging or with a punch biopsy done by a breast surgeon in the office.
The bottom line is that if your nipple has always been turned inward, it’s not likely a cause for concern. But if this is new or comes with a lump or skin changes, please get checked out by a health care provider.
A quick note about breastfeeding: It can still be possible, even with an inverted nipple! A lactation consultant can be helpful if a new parent with inverted nipples is having difficulty breastfeeding — but pregnancy or breastfeeding sometimes naturally fixes the problem.
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