The breast is unique to mammals. It differentiates mammals from other species. It serves to provide nourishment from mother to her offspring. The nipple is typically elevated, or everted, above the surface of the breast and contains 15 to 20 milk ducts, which allows for the passage of milk from the breast gland. The nipple is surrounded by the areola, a sheet of fibromuscular tissue and skin.

Inverted Nipples - Before & After

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Levels Of Severity

In 1999, a grading system was described by Han and Hong. It is still used today to describe the severity of inverted nipples. In addition to being able to classify a patient’s condition, it helps to predict the success of the variety of different treatments. There are three grades.

Grade I

In Grade I, the problem is mild. The nipple can easily be everted with gentle pinching and can usually maintain an everted position for a short time while the areola contracts. Surgical correction of this grade can usually be accomplished with just a buried suture at the base of the nipple. Sensation and the ability to breastfeed should be maintained.

Grade II

Grade II inverted nipples can also be manually everted, but it takes a lot more effort. Also, it does not stay everted and quickly becomes inverted when released. Usually the ducts are not too short but being pulled downward by the fibrous tissue. The ducts can be released by dividing the deep fibrous tissue. Adding the buried suture maintains the everted position and completes the procedure. Usually sensation and the ability to breastfeed are maintained, though not guaranteed.

Grade III

Grade III is the most severe. The nipple cannot be everted manually. There is a lot of fibrous tissue that keeps the nipple inverted, and the ducts might be physically shortened. This is the most difficult grade to successfully treat. There have been many types of procedures designed to correct these inverted nipples. They all have certain things in common. They divide the fibrous tissue, keep the nipple everted after surgery with a traction suture and add tissue into the nipple. Adding tissue helps to add bulk, which is lacking once the nipple is everted. The tissue usually comes from small “flaps” created from the adjacent areola.

Intra-operative view of intact ducts after removal of fibrous tissue

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Patient Testimonial

"I had a wonderful experience with Dr. Schuster and his entire staff. Very professional, personable and helpful. My procedure went very smooth and I am very pleased with my results. I would highly recommend!"

What Are The Risks Of Inverted Nipple Surgery?

In addition to adding bulk, the flaps can serve as a sling to keep the nipple everted. The drawback in these techniques is that there is a lot of cutting beneath and within the nipple. This can divide the ducts, nerves and blood vessels. This can result in the inability to breast feed, numbness and, in some cases, can cause a problem with circulation and healing. Finally, in spite of all of these efforts, there is always a chance of relapse.

How Dr. Schuster Performs Inverted Nipple Surgery

Dr. Schuster’s choice of correction of Grade III inverted nipples is to perform the surgery with the help of a magnifying small joint arthroscope. This technique was first reports by Chen, et al, in 2007. By using the arthroscope, the surgery can be performed through a very small incision placed at the base of the nipple. The scope magnifies the area so that the fibrous tissue can be divided while leaving the ducts, nerves, and vessels alone. Then a small strip of skin is taken from a well-concealed area in the groin, and placed into the nipple to provide the needed bulk. A buried suture is added at the bottom and a suspension suture is worn for a week. Although it is a technically more demanding surgery, and takes a bit longer to perform, Dr. Schuster believes it has the highest success rate and the best chance to preserve sensation and the possibility to breastfeed.

Is The Surgery Painful?

The surgery is performed on an outpatient basis under IV sedation. It is not painful after surgery. A slightly bulky bandage is worn for a week. Light protection is needed for six weeks after surgery. Exercise can be resumed three weeks after surgery.

The inverted nipple correction procedure usually takes around a half hour per side. It does, however, depend on the degree of inversion. If it is only a minor correction, the operation can take as little as 15 minutes. 

No, the procedure itself is not painful. Before an inverted nipple procedure can take place, patients are given a local anesthetic. You may feel slight discomfort from the anesthetic, but you will not feel anything from the procedure. Be sure to consult the surgeon regarding the anesthesia before the operation begins. 

Recovering from the initial procedure and returning to your semi-normal routine can take about a week or two. For a full recovery from an inverted nipple procedure, it can take up to six weeks. However, recovery can potentially take longer, depending on your health.

Inverted nipple surgery is usually a safe procedure, but it does have a few risks you need to consider.

The risks of inverted nipple surgery include the following:

  • Bleeding
  • Contracting an infection in the treated area
  • Asymmetry
  • Scarring
  • Changes in nipple sensation
  • Reoccurring nipple inversion
  • Undesired aesthetic results
  • Inability to breastfeed

Dr. Ronald Schuster will go over these risks during your consultation with him. He will go over your medical history, habits, and past surgical complications to see whether or not you are a suitable candidate for inverted nipple surgery.

The ideal candidates are patients who are unhappy with the appearance of their inverted nipples or are unable to breastfeed due to nipple inversion. Patients should be in relatively good health, not pregnant or currently breastfeeding, and have realistic expectations regarding the procedure. 

Schedule a Consultation

To learn more about how Dr. Schuster treats inverted nipples, please call our office at 410-902-9800 to schedule a consultation.



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Location Map: 10807 Falls Rd #101 Lutherville-Timonium, MD 21093
10807 Falls Rd #101
Lutherville-Timonium, MD 21093

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