Flat and Inverted Nipples

What is a flat or inverted nipple?

Flat nipples lay even with your surrounding breast tissue. Inverted nipples point inward toward your breast instead of sticking out. Inverted and flat nipples are usually just harmless variations of healthy breast anatomy.

Though flat and inverted nipples are typically harmless, sudden changes in the color or shape of your nipples could indicate an underlying health condition. If your nipples invert or change suddenly, let a healthcare provider know.

Your nipples might be:

• Protruding. Your nipples stick out from your surrounding breast tissue.
• Flat. Your nipples lay flat and even with your surrounding breast tissue.
• Inverted. Your nipples pull inward, tucked inside your surrounding breast tissue.

How common are flat and inverted nipples?

About 10% to 20% of the general population has flat or inverted nipples.

What causes flat or inverted nipples?

There can be many reasons why someone has flat or inverted nipples. Possible causes include:

• Fetal development. Your nipples developed while you were still a fetus. They may appear flat or inverted because your nipple base is small or because your milk ducts didn’t fully form during fetal development.
• Breast injuries. Scarring from breast surgery or even breastfeeding (chestfeeding) can change your nipple’s tissue.
• Infections. Bacteria can invade your nipple and cause an abscess or mammary duct ectasia (when your milk ducts get clogged). These conditions can result in flat or inverted nipples.
• Age-related breast changes. Your breasts change as you age. Leading up to menopause, your milk ducts may shorten, causing your nipples to invert or lay flat.
• Pregnancy. Your nipples may flatten as your breasts become filled with milk during pregnancy.
• Breast engorgement. Engorgement can cause your nipples to appear flat or inverted. This usually resolves once the swelling goes down.
• Benign breast disease. Flat or inverted nipples are a common symptom in people with benign breast disease. This condition causes noncancerous breast lumps.
• Paget’s disease of the breast. This rare type of breast cancer develops in the skin of your nipple. Sometimes mistaken for eczema, Paget’s disease of the breast can cause symptoms like skin rash, inflammation, or a flat or inverted nipple.
• Breast cancer. When a breast tumor invades a milk duct, it can cause your nipples to flatten or invert.

Flat or inverted nipple cancer symptoms

Flat or inverted nipples usually don’t indicate cancer. But if your nipple’s appearance changes suddenly, talk to a healthcare provider. It could be a sign of underlying disease.

People with breast cancer may notice that their nipple suddenly becomes flat or inverted. Additional breast cancer symptoms may include:

• A lump in your breast or armpit.
• Any change in your breast’s shape or size (especially if you notice changes in just one breast or nipple).
• Dimpling of breast skin (resembling an orange peel).
• Flaky or itchy skin (pruritus) in your nipple area.
• Nipple discharge.
• Breast pain.

How do healthcare providers diagnose flat or inverted nipples?

A healthcare provider can tell you if your flat or inverted nipples are a cause for concern. They’ll do a physical examination to see if they feel any lumps or bumps. They may also recommend tests to rule out other conditions. These tests may include:

• Mammogram.
• Breast ultrasound.
• MRI (magnetic resonance imaging).
• Needle biopsy (to test for cancer cells).

How do healthcare providers treat flat or inverted nipples?

Flat or inverted nipples don’t always need treatment. But if a condition causes flat or inverted nipples — or you just want to enhance the appearance of your nipples — your provider will help you choose a treatment based on your specific needs.

Antibiotics

If an infection causes flat or inverted nipples, a provider can prescribe antibiotics. They can also drain or surgically remove any abscesses.

Flat or inverted nipple breastfeeding treatments

Flat or inverted nipples might make it difficult for your baby to latch during breastfeeding. While it can be challenging at first, you can still breastfeed with flat or inverted nipples. There are things you can try to coax your nipples outward, making it easier for your baby to attach. These include:

• Hoffman technique. Place your thumbs on either side of your nipple. Then, press down while pulling your thumbs apart to encourage your nipple to pop up so that your baby can latch.
• Manual stimulation. Nipples are erectile tissue. Gently place your thumb and forefinger around your nipple and make a rolling motion or apply cold to it to encourage it outward. Side-lying while feeding your baby can make this even more successful. (In this position, you and your baby lie down facing each other. Your baby’s mouth should be level with your nipple.)
• Suction device. Your baby is often the best tool to draw your nipple out. But you can also use a suction device like inverted nipple correctors or a breast pump to draw out your nipple. Please note, your baby should latch onto your areola and not your nipple. So, getting a deeper latch can often solve these issues.

If these methods fail, consider talking with a lactation consultant. They may recommend nipple shields. Nipple shields are thin silicone covers that can help your baby latch. Be sure to discuss the pros and cons of nipple shields with your healthcare provider.

Cancer treatments for flat or inverted nipples

When breast cancer causes flat or inverted nipples, you’ll meet with an oncologist to discuss your treatment options, which might include:

• Surgery.
• Chemotherapy.
• Radiation therapy.
• Hormone therapy.

Cosmetic surgery for flat or inverted nipples

Nipples come in all varieties, including flat and inverted. But if you feel self-conscious about your nipples, your provider can recommend plastic surgery procedures to make them more protruded.

How can I reduce my risk of flat or inverted nipples?

Most of the time, people are born with flat or inverted nipples. In these cases, there’s nothing you can do to prevent them.

But you can reduce your risk of infection by not smoking. Most people who have periductal mastitis (a chronic infection of breast tissue) use tobacco products. The condition causes many symptoms, including nipple inversion.

Do inverted nipples ever go away?

Inverted nipples don’t usually go away on their own. If you’re concerned about their appearance, speak with your provider about surgical options. Or, ask your provider about options for training your nipple outwards, like the Hoffmann technique. Your provider can discuss short-term and long-term solutions based on what’s causing your nipples to invert and what grade of inversion they are.

Can you breastfeed (chestfeed) with flat or inverted nipples?

Yes, it’s totally possible to breastfeed with flat or inverted nipples. Your healthcare provider can recommend ways to turn your nipples outward so your baby can latch.

It’s normal to feel frustrated when faced with these challenges. But your provider is here to help.

When should I see my healthcare provider?

Your provider needs to know if you’ve noticed sudden changes in your breast, like inverted nipples. This change may signal an underlying issue that requires treatment.

Can piercing my nipples help correct inversion?

Some people get nipple piercings to help their inverted nipples protrude more. The idea is that the jewelry will keep your nipple erect.

It’s important to know that inverted nipple piercing doesn’t work for everyone. It can also make you more prone to infections. (Not to mention, it can be painful.) You also shouldn’t get your nipples pierced if you plan on breastfeeding. Before you get your nipples pierced, talk to your healthcare provider about risks and benefits.

A note from Cleveland Clinic

Having flat or inverted nipples doesn’t mean there’s something wrong with you. In fact, healthy nipples come in many shapes and sizes. But if you want to fix inverted or flat nipples — whether it’s to breastfeed or simply to boost your confidence — your healthcare provider can find a treatment that works for you and your specific needs.