Patient's question:
I don't know what's going on. My chest is very flat, and I don't have nipples either. I've always felt very insecure. I don't know if it can be treated.Doctor's answer:
If an adult female's nipple is concave and retracts below the surface of the areola, not protruding above the plane of the areola, creating a sizeable orifice-like appearance, it is referred to as nipple inversion. The degree of nipple inversion varies, with some cases only showing retraction of the nipple, while severe cases may involve the nipple being concave or even inverted. Nipple inversion not only affects the aesthetic appearance of the breast but also hinders breastfeeding function. The affected area is difficult to clean, and the recessed portion can easily accumulate dirt and debris, often leading to local infections. Since the milk ducts are connected to the, inflammation can spread into the breast tissue, causing mastitis. Therefore, correction is necessary.Nipple inversion is primarily congenital but can also be caused by trauma, surgery, breast tumors, or fibrosis following mastitis. The primary cause of congenital nipple inversion is poor development of smooth muscle in the nipple and areola. These muscle fibers pull inward, and the lack of supportive tissue beneath the nipple contributes to the inversion. Nipple inversion typically occurs bilaterally but can also affect only one side. Mild nipple inversion, also known as reversible nipple inversion, is characterized by the nipple returning to its normal position with slight squeezing or pulling. This type of inversion can be corrected through non-surgical conservative treatments, with the best timing being before marriage or in the early stages of pregnancy.
Specific methods include manual traction and mechanical traction.
Manual Traction: The individual manually pulls the nipple out of the skin using the thumb and index finger, either horizontally or vertically, and applies sustained or intermittent outward traction for about 30 minutes per session. Bilateral nipples should be alternated, with 3–5 sessions per day.
Mechanical Traction: A manual or electric breast pump is used to create negative pressure, drawing the nipple out. The same sustained or intermittent pulling for 30 minutes per session is applied, with bilateral alternation and 3–5 sessions per day.
Both methods can yield good results after two months.
Irreversible nipple inversion, or severe inversion, requires surgical correction. The surgery involves completely releasing the retracted muscle fibers and filling the area beneath the nipple with surrounding tissue to enhance support, thereby lifting the nipple and reshaping it. The procedure is typically performed under local anesthesia, with various techniques available based on individual circumstances. The surgery is conducted within the areola, resulting in minimal scarring and no damage to the sensory nerves of the nipple, so normal sensation is preserved postoperatively. The surgery generally does not disrupt milk ducts, thus avoiding breastfeeding complications.