Public parking available or drop off along Arab Street, Village Hotel Bugis (Previously known as Golden Landmark Hotel)
Buses (2, 12, 32, 33, 130, 133, 133A, 520, 960, NR7) MRT (alight at Bugis MRT station)
Public parking available or drop off along Arab Street, Village Hotel Bugis (Previously known as Golden Landmark Hotel)
Buses (2, 12, 32, 33, 130, 133, 133A, 520, 960, NR7) MRT (alight at Bugis MRT station)
Some studies have reported that inverted nipples affect between 2% and 10% of women [1], while other research indicated that "as many as 10% to 20% of females are born with one or both inverted nipples." [2]
This condition can be both congenital and acquired, and it may occur unilaterally (on one side) or bilaterally (on both sides). Both flat and inverted nipples can occur in men and women, potentially causing physical discomfort and functional limitations.
The average nipple and areola vary in size, colour, and shape. Typically, the height and diameter of the nipple are about 1 cm, while the average diameter of the areola is approximately 3 cm [3]. There are five recognised nipple shapes: rectangular, omega, round, cup, and slanting [4].
Congenital nipple inversion, which is caused by genetics, does not have any health implications and is not a sign of an underlying medical condition. It is considered a benign congenital maldevelopment.
Flat nipples are level with the surrounding breast tissue.
Inverted nipples point inward toward the breast rather than protruding outward.
Factors that can cause flat or inverted nipples include:
As your body prepares for lactation, your breasts undergo changes to get ready for breastfeeding.
Your nipples may flatten or become more prominent, and the areolas may darken and enlarge.
Scarring from surgery or breastfeeding can lead to changes in the tissue of your nipple, potentially affecting its appearance, texture, and sensitivity.
A breast tumour that invades a milk duct can change the appearance of the nipple, causing it to flatten or invert.
During the fetal stage, the nipples begin to form. This development is closely linked to the formation of milk ducts.
If the milk ducts are not fully developed or the base of the nipple is small, it may result in flat or inverted nipples.
This is the most common.
A bacterial infection leading to mastitis, which occurs when bacteria enter the body through the nipples, may cause inverted nipples.
This is common in breastfeeding mothers when milk ducts become blocked, preventing milk from flowing out.
In the early stages of breastfeeding, breasts often become engorged. When they become overly full with milk, your nipples might appear flat or inverted.
Typically, this issue resolves on its own once the swelling in the breasts subsides.
As you age, your breasts, including the nipples, go through various changes.
In the years leading up to menopause, hormonal fluctuations can cause the milk ducts to shorten, which may lead to flat or inverted nipples.
Flat or inverted nipples can be a common symptom of benign breast disease.
This condition is characterised by noncancerous breast lumps, which can alter the appearance of the nipples.
Paget's disease typically begins in the nipple area and may spread to the areola.
Symptoms include a flattened or inverted nipple, as well as a red, scaly rash on the nipple and areola.
Inverted nipples are classified into three grades according to Han and Hong [5], based on the degree of fibrosis, the ease of manipulation, and the extent of damage to the lactiferous ducts.
The nipple can be easily pulled out with gentle palpation (a physical examination technique using the fingers or hands).
It maintains its projection well without any traction. The lactiferous ducts (milk-carrying ducts) are normal.
The nipple can still be pulled out by palpation, but with more difficulty, and it tends to retract.
This grade exhibits moderate fibrosis, and the lactiferous ducts are mildly retracted.
This is a severe form of inverted nipple, characterised by significant inversion and retraction. Manually pulling the nipple out is difficult, requiring a traction suture to keep it protruding.
There is severe fibrosis beneath the nipple, and the surrounding soft tissue is inadequate.
Inverted nipples can present several disadvantages. They include:
• Prevent the ability to naturally breastfeeding [7]
• Cosmetic dissatisfaction may lead heighten self-consciousness during intimacy [8]
• Sore nipples or mastitis may develop due to clogged milk ducts in mothers with inverted nipples during breastfeeding [9]
• A suddenly inverted nipple can be a sign of cancer, breast abscess, or a lump [10], so do seek professional opinion should you experience this
• Frequently experiences inflammations of the nipples
Natural techniques to fix inverted nipples are usually temporary. The common methods include:
Some natural methods people use to address inverted nipples involve suction devices, such as nipple retractors, nipple extractors, shells, and cups. These devices are typically worn beneath clothing or a bra for a period of time.
They work by gently pulling the inverted nipples outward, with the aim of loosening the surrounding tissues and helping the nipples remain erect for longer durations.
However, there is currently no scientific evidence to support the effectiveness or durability of the results from using these devices.
A study published in the International Breastfeeding Journal examined mothers with inverted nipples who faced challenges with breastfeeding.
The mothers were advised to use a 10-cc inverted syringe before each breastfeeding session. This method involved placing the base of the inverted syringe over the inverted nipple and gently pulling it until the nipple was everted (protruded), holding it in that position for one minute.
After this, the syringe was removed, and direct breastfeeding was initiated. While this method is temporary, the syringe is readily available and is affordable [11].
The Hoffman technique for drawing out inverted nipples has been used globally since the 1950s.
To encourage the nipple to protrude, place your thumbs on either side of the areola and press down while pulling your thumbs apart.
There is no empirical evidence regarding the success rate of applying this technique regularly to address inverted nipples.
This method is often used to assist with latching during breastfeeding.
If desired, this condition can be corrected through a surgical procedure known as Nipple Retraction/Correction.
The patient will be under twilight sedation during the procedure.
Once the patient is lightly sedated, an incision will be meticulously made around the base of the nipple and the areola.
Special care will be taken to ensure precision and minimal tissue disturbance.
Image source: Figure 1
The procedure follows the same steps as the surgery for Inverted Nipple Correction With Partial Preservation Of Milk Ducts, with one exception: depending on the severity of the nipple inversion, the milk ducts may not be preserved.
This will be discussed during your consultation with your doctor.
Image source: Figure 2, 3, 4
In rare cases, some patients may experience a loss of nipple sensitivity. However, Amaris B. Clinic's Inverted Nipple Retraction/Correction Surgery has a high success rate and overall patient satisfaction.
After any surgery, it’s important to allow yourself 2 to 3 days of rest. Patients should avoid heavy lifting and water activities for a couple of weeks following the procedure. It’s normal to experience soreness, tenderness, and sensitive nipples, but these symptoms should diminish in a few days.
Itchiness may occur as your wounds heal, so it's important to take any anti-itch medication prescribed by your doctor. Avoid scratching your wounds, as this can hinder your recovery. While scarring may happen, it is typically located within the areola to minimise visibility.
Dr Ivan Puah is an accredited liposuction doctor and Chairman of Lipo Peer Review Committee in Singapore in Singapore with nearly two decades of surgical body contouring experience. He has completed fundamental and advanced Vaser Liposuction body sculpting surgical training under Dr John Milard and Dr Alfredo Hoyos in Argentina and Colorado.
Dr Puah is also trained in laserlipolysis (laser liposuction) in Italy and has received dedicated gynecomastia surgery training in San Francisco.
Dr Ivan Puah is known for his aesthetic sense and meticulousness. Effective doctor-patient communication is paramount in the realm of aesthetics and he truly takes the time to understand each patient’s unique needs, and goals and tailors his treatment accordingly.
Dr Puah marries the principles of science and art in liposuction and gynecomastia surgery, delivering natural and optimal body contouring results for his patients.
How long does Inverted Nipple Retraction/Correction Surgery take?
Inverted Nipple Retraction/Correction Surgery will be conducted in a fully accredited and licensed facility by the Ministry of Health Singapore. The entire procedure will take between 1 and 1.5 hours, depending on the patient's condition and the techniques applied by the doctor.
How much does it cost to correct inverted nipples in Singapore?
The cost of inverted nipple retraction or correction surgery in Singapore depends on several factors. These include whether the procedure is for one nipple (unilateral) or both nipples (bilateral) and the specific practice you choose. The price may vary based on the doctor's experience and whether a histology (biopsy) is required.
Is Inverted Nipple Retraction/Correction Surgery covered by MediSave or Insurance?
Whether in part or whole, health insurance policies in Singapore and MediSave accounts do not cover the costs associated with Inverted Nipple Retraction or Correction Surgery.
Suitable Candidates for Inverted Nipple Retraction/Correction Surgery
Men and women in generally good health with Grade I to III inverted or flat nipples are ideal candidates for Inverted Nipple Retraction/Correction Surgery. However, breastfeeding mothers or pregnant women are not eligible for this surgery. It is recommended to wait at least 6 months after giving birth or breastfeeding before undergoing the procedure.
How old do you have to be to get Inverted Nipple Retraction/Correction Surgery?
Individuals aged 18 and older, with fully developed breasts or chest, who experience nipple inversion may be eligible for Nipple Retraction/Correction Surgery in Singapore.
Can nipple piercings fix inverted nipples?
Nipple piercings are a controversial method for addressing inverted nipple issues. Some women opt to have their nipples pierced in the hope that the piercing will keep their nipples constantly protruding. However, we do not recommend this method for women who are nursing.
Is Inverted Nipple Retraction/Correction Surgery painful?
Nipple Retraction/Correction Surgery is painless as you will be under twilight sedation. After the procedure, you may feel pain and discomfort in the area, but it should last for only about two weeks.
Reference
[1] Mangialardi ML, Baldelli I, Salgarello M, Raposio E. Surgical Correction of Inverted Nipples. Plast Reconstr Surg Glob Open. 2020 Jul 27;8(7):e2971. doi: 10.1097/GOX.0000000000002971. PMID: 32802664; PMCID: PMC7413770.
[2] Nagaraja Rao D, Winters R. Inverted Nipple. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563190/
[3] Snyder CC, Pickens JE, Slater PV. Master FW, Lewis JR., Jr Surgery of the areola-nipple complex. In: Symposium on Aesthetic Surgery of the Face, Eyelid, and Breast. 1972:St. Louis: C. V. Mosby; 192–200.
[4] Kim JT, Lim YS, Oh JG. Correction of inverted nipples with twisting and locking principles. Plast Reconstr Surg. 2006;118:1526–1531.
[5] Han S, Hong YG. The inverted nipple: its grading and surgical correction. Plast Reconstr Surg. 1999;104:389–395; discussion 396.
[6] Peeters G, Decloedt J, Nagels H, Cambier B. Treatment of the severe or recurrent inverted nipple by interposition of a resorbable polydioxanone sheet. J Plast Reconstr Aesthet Surg. 2010 Feb;63(2):e175-6.
[7] Youssef Ahmed Abd-Ella, N., & Fouad Mohammed, S. (2021). Effectiveness of Hoffman's Exercise on the Level of Breastfeeding among Primiparous Women with Inverted Nipple. Egyptian Journal of Health Care, 12(1), 607-624.
[8] Berenguel-Pérez, A. I., & Cortés-Rodríguez, A. E. (2024). Reduction mammoplasty, self-esteem, and sexual desire: A pre-post intervention study. International Journal of Clinical and Health Psychology, 24(3), 100477.
[9] Amir, L. H., Baeza, C., Charlamb, J. R., & Jones, W. (2021). Identifying the cause of breast and nipple pain during lactation. bmj, 374.
[10] Jensen, N. C., Kirven, R. M., & Korman, A. M. (2024). Hidradenitis Suppurativa-Induced Breast Abscess and Congenital Nipple Inversion Mimicking Inflammatory Breast Cancer with Review of the Literature. Academic Dermatology, 2(1), 1–6. https://doi.org/10.18061/ad.v2i1.9475
[11] Nabulsi, M., Ghanem, R., Smaili, H. et al. The inverted syringe technique for management of inverted nipples in breastfeeding women: a pilot randomized controlled trial. Int Breastfeed J 17, 9 (2022). https://doi.org/10.1186/s13006-022-00452-1
Image sources
Figure 1
(A) Four incisions were made at the 12, 3, 6, and 9 o’clock points. The first horizontal mattress suture extended from the 6 o’clock point to the 12 o’clock point.
(B) Schematic drawing of the 2 horizontal mattress sutures in a perpendicular direction.
(C) The start of purse-string suture placement through an incision at the 6 o’clock position, and reinsertion of the suture through the stitch exit points.
(D) Schematic drawing of the purse-string suture.
(E, F, G) Schematic drawing of the operative procedure of Gould et al. [Reprinted from “ Inverted nipple repair revisited: a 7-year experience”, by Gould DJ, Nadeau MH, Macias LH, and Stevens WH, 2015, Aesthet Surg J, 35, pp.156-64. Copyright 2015 by the Oxford University Press.
Figure 2
Step-by-step description of nipple depression valgus operation with traction. First place the mosquito forceps at the centre of the sunken nipple (A), then pull the mosquito forceps out of the centre of the nipple (B), then pull the oil yarn out of the centre of the nipple (C), and finally sew on the side of the nipple (D).
Figure 3
Nipple depression with perfect development. Sew “-” on both sides of the nipple root, respectively, (A) then turn the nipple out and tighten the knotted suture, respectively, (B).
Figure 4
Nipple depression with imperfect development. Sew semicircular suture on both sides of the nipple root (A), then gradually tighten the suture and tie the knot while turning the nipple outward (B).
Dr Ivan Puah's novel 360° Glandular Tissue Dissection (360°GTD®) technique minimises surgical invasiveness while achieving cosmetic results.
Dr Ivan Puah's novel 360° Glandular Tissue Dissection (360°GTD®) technique minimises surgical invasiveness while achieving cosmetic results.
Dr Ivan Puah's novel 360° Glandular Tissue Dissection (360°GTD®) technique minimises surgical invasiveness while achieving cosmetic results.
