Patient's question:
My nipples are not only flat but also have small bumps. Over time, they may secrete discharge, forming dark crusts similar to scabs. Every time I clean the crusts, I can see these small bumps. I want to ask, now that I am pregnant, what should I pay attention to? Can I breastfeed in the future?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, forming a mouth-like appearance locally, 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, making it difficult to clean the affected area. The recessed portion is prone to accumulating dirt and debris, often leading to local infections. Since the milk ducts are connected to theed area, inflammation can spread to 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 main reason for congenital nipple inversion is the underdevelopment of smooth muscle in the nipple and areola, causing these muscle fibers to pull inward. Additionally, the lack of supportive tissue beneath the nipple contributes to inversion. Inversion can occur bilaterally or unilaterally. Mild nipple inversion, also known as correctable nipple inversion, can be restored with slight squeezing or pulling of the nipple. 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: Gently pull the nipple out of the skin using the thumb and index finger, holding it horizontally or vertically, and apply continuous or intermittent outward traction for about 30 minutes. Alternate between both nipples. Perform 3-5 sessions per day.
Mechanical traction: Use a manual or electric breast pump to apply negative pressure and pull the nipple out. The same duration of traction (30 minutes) and alternating sessions apply, with 3-5 sessions per day.
Both methods can yield good results after about two months. In cases of irreparable inversion, also known as severe inversion, surgical correction is the only option. The surgery involves completely releasing the pulling muscle fibers and filling the area beneath the nipple with surrounding tissue to enhance support, lifting the nipple, and reshaping it. The procedure is typically performed under local anesthesia, with various techniques available depending on the individual's condition. The surgery is conducted within the areola range, leaving minimal scarring, and does not damage the sensory nerves of the nipple, ensuring normal sensation post-surgery. The surgery generally does not disrupt milk ducts, so breastfeeding is not affected.
It is worth noting that even after surgical correction, nipple inversion may recur. Therefore, manual traction for 1-2 months post-surgery is recommended, with mechanical traction available for reinforcement.
"Army General Hospital's 'Skillful Hands' Enhance 'Beautiful' Nipples—Pulled Back Nipples Return to Normal with a Pull"
http://www.sia.com.c2001083113：45 Yangtze Evening News
Report from Yangtze Evening News
A female patient with severe nipple inversion recently regained normalcy after treatment with the nipple inversion lifter developed by the Plastic and Burn Surgery Department of the Army General Hospital. Congenital nipple inversion severely affects women's physical and mental health, and previous surgical methods often led to mastitis or breast abscesses. Dr. Jiang Huiqing of the Plastic and Burn Surgery Department of the Army General Hospital pioneered the development of the nipple inversion lifter in the Asia-Pacific region. Utilizing physical negative pressure, the device is attached to the inverted nipple, and after three months of negative pressure, the nipple protrudes and returns to normal. The lifter is small and exquisite, worn inside a bra without affecting the appearance of the chest. The device has been granted a national invention patent. (Gong Yi)
Adolescence—The Best Time to Correct Nipple Inversion
http://www.sia.com.c2000111112：31 Health 123
A normal nipple is cylindrical, extending about 1.5-2 cm above the breast plane, appearing as a nodule. If the nipple does not protrude above the breast skin and does not protrude when pulled, it is called nipple inversion. Although this condition does not directly affect marriage, it can hinder emotional and sexual communication, make breastfeeding difficult post-pregnancy, and easily lead to local inflammation or eczema. Severe cases may cause dilated breast duct syndrome. Therefore, nipple inversion should be corrected during adolescence. First, visit a hospital to rule out breast inflammation or other diseases, then try self-treatment methods:
1. Gently pull the inverted nipple out of the breast and hold it in place for a period. If this method is ineffective, try the syringe suction method.
Prepare a 10-mL plastic syringe, remove the outer casing of the syringe tip, withdraw the needle, and invert the syringe. Align the open end of the outer casing with the inverted nipple. Insert the needle from the cut end of the syringe tip and gently suction, using the negative pressure to pull the nipple out and hold it for 5-6 minutes. Repeat 1-2 times daily.
Currently, there is a "nipple lifter" on the market with a similar principle but can hold the nipple in place for longer periods, allowing it to be worn during daily activities. When using a lifter, apply suction 1-2 times daily for 30 minutes. If no adverse reactions occur, gradually increase the suction time. After about 30 days, the nipple can be pulled out, followed by 2-3 months of consolidation treatment.
Wear bras that are not too tight and leave space for the nipple to avoid pressure. If these treatments are ineffective, surgical correction in the plastic surgery department of a hospital can be performed, with excellent results that do not affect future marriage, childbirth, or breastfeeding.