Definition

Nipple retraction is a condition where the nipple of the breast is drawn inward. This makes the tip of the nipple look like it is going into or flat with the areola (the dark colored area that surrounds the nipple). This condition can be experienced by 10-20% of the general public, and can occur in one or both breasts.

Both men and women can have sunken nipples. You can be born with this condition. However, if sunken nipples appear later, this complaint can be a sign of a medical condition that must be examined by a doctor.

Cause

Birth Conditions

In the womb, the nipples develop in the third trimester. During pregnancy, the nipples may not protrude and still point inward at birth, this happens because the base of the nipple remains small during pregnancy or the milk ducts do not develop perfectly. As a result, the nipple is drawn inward.

Aging Process

Starting in your mid-30s, your breasts will continue to change as you age. The milk ducts (lactiferous ducts/mammary duct) located in the breast can shorten when approaching menopause. Sometimes this can cause the nipple to be drawn inward. Because the risk of breast cancer increases with age, you need to see a doctor if there are changes in your nipples.

Breast Infection

Bacteria can enter the milk ducts and cause an infection. A condition called mastitis periduktal this occurs especially in women who have just given birth or are breastfeeding. Bacteria can also enter women who have piercings on their nipples or nipples that are cracked (cracked nipple).

Symptoms that may occur due to bacterial infection are:

• Pain, redness and heat in the breast.
• The discharge of blood-mixed fluid from the nipple.
• A lump on the back of the nipple.

If there is an infection in the milk glands under the areola of the breast, a lump containing pus (abscess) can form. This condition can also make the nipple pulled inward.

We also have an article on cracked nipples that you can read here: Sore Nipples - Definition, Causes and Risk Factors.

Risk Factors

There are several risk factors for inverted nipples, including:

Breast Paget's disease

This disease is rare and is associated with breast cancer. Changes occur in the nipple and areola. In addition to nipple erosion, Paget's disease can also cause pain, itching, peeling skin and fluid coming out of the nipple.

Mammary Duct Ectasia

The channel that carries milk to the nipple can experience dilation (ectasia) and become clogged. The condition is called mammary duct ectasia this usually attacks women aged 45-55 years. One of the symptoms of this disease is that the nipples look sunken. This blockage in the milk ducts can disappear on its own. However, if it does not heal, treatment with antibiotics or surgery can overcome it.

In addition to the two medical conditions above, factors that can also increase the risk of inverted nipples are:

• Sagging breasts
• Death of breast fat tissue due to injury/trauma (traumatic fat necrosis)
• Infection in the breast
• Sudden weight loss
• Side effects of breast surgery
• One of the symptoms of breast cancer is a nipple that is drawn inward.

Symptoms

The normal nipple is visible protruding out. The nipple will go into the areola so that the nipple tip will be seen to be buried or flat with the areola. 

From the degree of severity, sunken nipples can be divided into three, namely:

• Degree 1: The nipple can easily be pulled out and sometimes stands out on its own if it is stimulated or at a cold temperature. At this degree of inverted nipple, you can still breastfeed your baby.
• Degree 2: The nipple can be pulled out, but it will quickly return to its original shape. You may have difficulty breastfeeding.
• Degree 3: The nipple may not be able to be pulled out so that the breastfeeding process cannot be carried out.

Diagnosis

Nipples that are sunken can usually be seen immediately when a woman reaches puberty. In many cases, nipples that appear before puberty will heal on their own after a woman reaches puberty. This condition usually does not cause health problems. Doctors will check if the complaint of sunken nipples is accompanied by other complaints that can lead to the diagnosis of other diseases.

To assess the degree of inverted nipples, your doctor will perform a palpation of the breasts and nipples. If inverted nipples only appear after puberty and are accompanied by other complaints such as bleeding from the nipple or lumps in the breasts, it is feared that the complaints occur due to malignancy or other medical conditions.

For this reason, your doctor may ask about disease history such as breast cancer in the family and a history of injury/trauma to the breast. In addition, the doctor may perform other examinations such as breast ultrasound, mammography, breast tissue sample biopsy and MRI to find out the underlying cause of sunken nipples.

Procedure

Nipple inversion that does not cause other complaints generally does not require any treatment. Treatment is done if you feel that this condition is aesthetically disturbing or hindering the breastfeeding process.

The process of breastfeeding itself can be considered as a treatment for sunken nipples, because the baby's action of sucking the mother's nipple can release the adhesion on the nipple that causes the nipple to go inside.

There is no specific treatment option that can be used as a standard in the management of inverted nipples. Doctors will assess the degree of inverted nipples that patients have. Surgical procedures are usually performed on inverted nipples of degree 2 that are persistent and degree 3.

The following are treatment options for inverted nipples.

Hoffman's technique

This technique is done by pressing both sides of the nipple on the areola using the thumb. Next you need to keep both thumbs away from the nipple. This way, the nipple can stick out. This method can be used on a slightly sunken nipple so that you can breastfeed your baby effectively. However, do not use this technique before you consult a doctor, especially if the possibility of a sunken nipple is caused by other diseases accompanying a sunken nipple.

Using Tools

Your doctor may recommend using a suction device including a breast pump, or using a needle-less syringe to pull on the sunken nipple.

In most cases, sunken nipples are treated through surgery. However, the surgical procedure is at risk of causing interference in the milk ducts, which can cause interference in the production of breast milk in nursing mothers. In some cases, the nipples can also be pulled back into after the procedure is performed.

Complications        

The condition of sunken nipples is usually not dangerous and does not cause certain medical conditions. This condition also does not affect breast milk production and mothers with sunken nipples should not stop breastfeeding their babies because of this.

However, in some cases caused by certain medical conditions such as breast cancer, various complications due to these diseases can arise, such as bleeding and infection.

Prevention

There is no special prevention to avoid this condition. You may be born with sunken nipples or have other diseases that cause this condition.

When should you see a doctor?

Immediately go to the doctor if the sunken nipple condition makes the breastfeeding process disrupted. You also need to immediately go to the doctor if there are signs and symptoms of other underlying diseases of sunken nipples, such as lumps in the breasts and the appearance of blood-mixed fluid from the nipple.

Want to know information about other diseases? Check it out here, yes!