3 grades of inverted nipples and their treatment options

Aurora Clinics: Photo showing Inverted nipple surgery before and after

Aurora is now part of The Private Clinic, a nationwide group of clinics with over 35 years of experience specialising in Cosmetic Surgery and Skin and a Trust Pilot 5 star rating. For comprehensive information, before and after photos and costs on Inverted Nipple procedures click here.

Our expert Plastic Surgeon Adrian Richards is the Medical Director for The Private Clinic. Clinics are located in Birmingham, Bristol, Buckinghamshire, Glasgow, London Harley Street, Leeds, Manchester and Northampton.

Inverted nipples are extremely common, with an estimated 10% of the population suffering from this condition. What most people don’t know is that it isn’t just a case of ‘in’ or ‘out’. There are in fact three different grades of inverted nipples.

So what do we mean by the ‘grade of inverted nipple’?

Firstly it’s good to understand what causes an inverted nipple. The inversion of your nipple is determined by the balance between your muscle contracting inside the nipple which pushes it outwards and the inward pull of your milk ducts. So when the pull of the milk ducts becomes stronger than the muscle inside the nipple, you will experience inversion.

So the ‘grade’ is a term we use to classify how severe your inverted nipples are, or in other words how tight your milk ducts are. Knowing the grade of your inverted nipples will help determine the best course of treatment to correct them.

As Consultant Plastic Surgeon and inverted nipple corrective specialist Mr Adrian Richards discusses in this video, there are three classifications, graded between 1 and 3 with 1 being the mildest and grade 3 being the most severe.

So let’s look at each grade in turn:

Grade 1

This is the mildest form of inverted nipple and is classified by either flat or slightly inverted nipples which when stimulated by touch or temperature variations become everted. The nipples then remain everted for a certain period of time before returning to their flat or slightly inverted position. Typically, if you have grade 1 inverted nipples you will still be able to breastfeed.

Grade 2

Grade 2 inverted nipples are more severe than grade 1, meaning they have a more inverted appearance. They are similar to grade 1 in that they become everted when stimulated however they will immediately go back in rather than everting for a sustained period of time. It is also still possible to breastfeed with grade 2 inverted nipples.

 

 

 

 

 

Grade 3

Grade 3 inverted nipples are the most severe with very short milk ducts and permanent inversion. This means even when the nipples are stimulated they will not evert. Unlike grade 1 and 2 inverted nipples if your nipples fall into the grade 3 category, it is very unlikely that you will be able to breastfeed.

 

 

Your Treatment Options

Our advice to you, regardless of which grade of inverted nipples you have, is to try the non-surgical approach first.

The non-surgical approach uses a device called a Nipplette. This is a discreet plastic suction cup which you place over your nipple and when used over time can lead to full eversion by gently stretching the milk ducts within the nipple. These devices can be bought from any high street chemist such as Boots.

This technique is very effective for grade 1 inverted nipples and can in some cases work for grade 2. The more severe your inverted nipples are the more likely you’ll need a surgical correction to achieve a more permanent result. However, we always recommend trying the non-surgical treatment as it may just provide enough eversion that you don’t have to go ahead with surgery.

If you have tried the Nipplette suction device and it hasn’t given you your desired results then your next option is corrective surgery. There are a number of different surgical techniques but they can be broadly split into two categories: stretching and dividing.

Stretching

As we explained earlier, the reason your nipples become inverted is because the milk ducts are shortened pulling your nipple inwards. So one technique to evert the nipples is to stretch these milk ducts which releases the pull on the nipple. This is seen as the less invasive option because it keeps the milk ducts intact. The major benefit of this is that it will not impact on your ability to breastfeed.

However, we have found that stretching the milk ducts often leads to a high rate of recurrence of the inverted nipples so many surgeons feel that particularly for grade 2 and 3 inverted nipples, the best solution in terms of longevity is actually to divide the milk ducts.

Dividing

Dividing the milk ducts means making an incision so that the milk ducts are no longer pulling the nipple inwards. From our experience this method produces much better and long-lasting results than the stretching technique. However, the downside of this technique is that you will not be able to breastfeed after having this procedure. Therefore, if you plan on breastfeeding it is important to discuss this with your surgeon as they may advise the stretching technique or simply waiting until after you have breastfed.

There are a number of different techniques your surgeon may use to divide your milk ducts. Each of which can result in varying scarring so it’s important to discuss with your surgeon which technique they’ll be using.

Insertion of substance
Trampoline effect
Splitting the nipple
Areola incision

We always encourage people to do as much research as they can when considering cosmetic surgery, so for more information on inverted nipple correction surgery: