Inverted nipples (sometimes called retracted nipples) sink inward or appear flat instead of protruding outward. This condition affects 10-20% of people, regardless of whether they were assigned female or male at birth. Inversion can affect one or two nipples and may be present from birth or develop later in life. 

Although usually harmless, inverted nipples can sometimes interfere with breastfeeding, lower self-esteem, or indicate an underlying health condition that needs attention. If your nipples change—especially if inversion happens suddenly or comes with tugging, pain, lumps, or discharge—consult a healthcare provider for further evaluation.

Inverted nipples sink inward instead of sticking out. Some may appear slightly flat, while others pull completely inside the breast. This can happen to one or both of your nipples, but the areola (the pigmented area around the nipple) does not typically change. Inverted nipples don’t routinely cause pain, but some experience discomfort when breastfeeding. 

The causes of inverted nipples range from natural variations to underlying health conditions.

Congenital Inversion

Congenital nipple inversion, which affects up to 10% of people, happens during the later stages of pregnancy and causes inverted nipples at birth. A slight dip in the breast tissue typically grows outward by the ninth month. If this doesn’t happen, the nipple stays below the surface, leading to inversion.

In 87% of cases, inversion occurs in both nipples, and about half of those with inverted nipples have a family history of it. This condition is usually harmless and often gets better during puberty. Treatment is unnecessary unless it causes discomfort, challenges breastfeeding, or affects self-esteem.

Aging and Breast Changes

As you age, breast tissue loses elasticity, which can cause nipple retraction. Hormonal changes, especially during menopause, further weaken the tissue supporting the nipple. Sudden weight loss can also lead to sagging and nipple inversion. These gradual changes are usually harmless, but it is important to watch for other signs like lumps, dimpling, or unusual discharge through breast self-exams.

Breastfeeding and Mastitis

Some people develop inverted nipples while breastfeeding due to the stretching of the milk ducts or conditions like mastitis.

Mastitis causes inflammation (swelling and irritation) of the breast tissue. It happens from either an infection or milk stasis, where breast milk builds up and doesn’t drain properly. The swelling presses on the milk ducts, causing the nipple to turn inward. The breast may become red, hard, painful, or swollen, and you may experience fever, chills, or flu-like symptoms.

Several things can cause milk to build up and block ducts, leading to inflammation, including:

• Longer gaps between breastfeeding sessions
• Overproduction of milk
• Poor latch, weak sucking, or tongue tie
• Pressure from tight bras
• Skipping feedings or rapid weaning

Breast Cancer

Though rare, sudden nipple inversion can sometimes be a sign of breast cancer. If you notice tugging of breast tissue, a breast lump, nipple discharge (clear or bloody), or any other changes on the breast, notify your healthcare provider. 

Trauma or Surgery

Injuries, surgeries, and certain medical procedures can lead to fat necrosis and scarring in the breast. Fat necrosis occurs when breast tissue loses blood flow, causing cell death and scar tissue formation.

Causes of fat necrosis include:

• Biopsies or fat grafting
• Breast injuries
• Radiation therapy (a type of cancer treatment)
• Surgical procedures (e.g., augmentation, reconstruction, or reduction)

Less Common Causes

While less common, these conditions can sometimes also lead to inverted nipples:

• Duct ectasia: Blockages or thickening of the milk ducts
• Paget’s disease: A rare form of breast cancer
• Tuberculosis: Primarily a lung infection, but can spread to other areas, including the breast

Seek medical advice if your nipples suddenly become inverted or if you notice any of the following symptoms:

• A lump in your breast
• Breast pain
• Nipple discharge
• Inversion in only one breast
• Redness, swelling, pain, or fever alongside nipple changes

Primary healthcare providers, along with specialists in obstetrics-gynecology (OB-GYNs), can assess the cause of inverted nipples and rule out serious conditions like breast cancer. They may order diagnostic tests, such as:

• Ductoscopy: Uses a scope to examine the milk ducts
• Magnetic resonance imaging (MRI): Utilizes magnets and radio waves to create images of the breasts and chest area
• Mammogram: Takes X-ray images of the breasts
• Needle biopsy: Removes a sample of tissue from your breast to check for signs of cancer or abnormalities under a microscope
• Ultrasound: Creates images of the breast using soundwaves

You usually don’t need treatment for mild cases. If you notice changes in appearance or have trouble breastfeeding, your provider might recommend surgery. They typically classify the severity of inversion into three grades:

• Grade 1: There is minimal scarring, and the milk ducts are normal. You can pull the nipple out, and it stays out for a short time. Breastfeeding is possible, but it might be tricky at first.
• Grade 2: There is more scarring, and the milk ducts are retracted. You can pull the nipple out, but it quickly retracts. Breastfeeding is possible, but latching may be challenging.
• Grade 3: Severe scarring prevents you from pulling the nipple out. Breastfeeding is almost impossible. This grade may also occur alongside symptoms like rashes, sore nipples, and frequent infections.

General Tips

Anyone with inverted nipples can use the following methods to improve appearance or feel:

• Hoffman’s exercises: Gently pull or roll the nipple between your thumb and index finger, applying light pressure. Repeat five times in both directions.
• Suction devices: Use gentle suction to pull the nipple outward. This method is suitable for managing inversion in both breastfeeding and non-breastfeeding people.
• Warm compress and massage: Apply a warm cloth for 10 minutes, then gently massage the breast for 15 minutes. This helps soften tissue and improve circulation. Warm compresses can also be helpful for inflammation or milk buildup.

Breastfeeding-Specific Tips

These tips are for people who are breastfeeding and need help with nipple protrusion to make feeding easier:

• Nipple shields: These devices act like a fake nipple, helping the baby latch and gently pulling the nipple outward.
• Suction devices: Use these devices before breastfeeding to pull the nipple out and help the baby latch.
• Partner sucking: Some studies suggest that having your partner gently suck the nipple before breastfeeding can help it protrude. More research is necessary to confirm its effectiveness.

Procedures

Your healthcare provider may also suggest a nipple retractor or piercing for a longer-term solution.

A nipple retractor is a small device, like the end of a syringe, that pulls the nipple outward. Your provider secures the device with tiny stitches, and you wear it for three to six months. This helps protect the milk ducts and makes breastfeeding easier. Your provider will regularly check to make sure the retractor is working.

A nipple piercing involves a stainless steel barbell piercing at the base of the nipple, similar to a body piercing. After three months, you remove the piercing, which helps the nipple stay in the correct position for at least 12 months. 

Surgery

For more severe cases (grade 2 or 3 nipple inversion), a plastic surgeon may perform surgery to release the tight tissue and retracted milk ducts. They may add support using internal stitches or small tissue flaps from the surrounding breast to prevent the inversion from recurring.

The surgery is minimally invasive, and you’ll typically receive local anesthesia so you won’t feel pain. The most common complication is the recurrence of nipple inversion, especially within a year of surgery.

You can’t prevent inverted nipples from birth or aging, but you can lower the risk from other causes. Early treatment of breast infections or inflammation can help stop problems that might lead to nipple inversion. For those who are breastfeeding, the following tips can also help manage or prevent inverted nipples:

• Make sure the baby latches deeply
• Change positions during feeds
• Gently press on the breast to help keep the nipple outward
• Use a breast pump before nursing to pull the nipple out, making it easier for the baby to latch, which helps prevent mastitis

Inverted nipples occur when the nipple retracts inward instead of protruding outward. It can happen for several reasons, such as being born with it, aging, infection, trauma, or underlying health conditions.

While inverted nipples are often harmless, it’s important to seek medical advice if inversion occurs suddenly or is accompanied by other symptoms like breast lumps or discharge. If you have concerns, consult a healthcare provider for diagnosis and treatment. With the right approach, many people successfully manage or correct inverted nipples.