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Nipple Deformities

What Are They, Signs, Symptoms, and More

Author: Nikol Natalia Armata, MD

Editors: Alyssa Haag,Stefan Stoisavljevic, MD,Kelsey LaFayette, DNP, ARNP, FNP-C

Illustrator: Jessica Reynolds, MS

Copyeditor: Stacy M. Johnson, LMSW

Modified: 3 Apr 2023


What are nipple deformities?

Nipple deformities are any congenital or acquired changes identified in the nipple and areola complex and are considered a type of abnormality of the breast. These deformities include accessory nipples (i.e., polythelia); nipple inversion or retraction; and rarely, the complete absence of the nipple (i.e., athelia). Most nipple deformities are present at birth; therefore, health care providers need to assess these changes in newborns to establish a baseline and monitor for changes throughout life. 

Anterior view of the chest with possible areas for nipple deformities outlined following the milk lines.

What causes nipple deformities?

Nipple deformities can be congenital (i.e., present at birth) or develop later in life. When individuals are born with a nipple deformity, the deformation most commonly occurs when the nipple and areola develop from the milk lines, which are a series of buds that span from the armpit to the groin and originate from ectoderm (i.e., one of the three primary germ layers formed in early embryonic development). Although most accessory nipples develop along the embryonic milk line, usually below the physiologic nipple, they may also appear on other body parts, like the back, shoulder, thigh, face, or vulva. Extreme ectodermal defects may cause a bilateral absence of the breasts.

On the other hand, nipple retraction or inversion at birth may be caused by the shortening of the breast ducts during gestation. Acquired nipple deformities typically develop later in life.

New nipple retraction or inversion may occur due to conditions that may disrupt the structure of the breast ducts, such as malignancy, inflammation, infection, or surgical procedures.

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How are nipple deformities treated?

Congenital nipple deformities usually do not require immediate treatment. Observation is critical when identifying and treating a congenital nipple deformity. Changes in their pigmentation may be treated with early excision and histopathological assessment. However, acquired nipple deformities are usually assessed for underlying causes, especially malignancy. Observation is critical when identifying and treating a congenital nipple deformity. 

Nipple deformities can be surgically reconstructed with plastic surgery when necessary. Although these deformities rarely have a long-term effect on the function of the breasts, they can have a severe psychological impact on the individual, especially adolescents. Reconstructive surgery by a plastic surgeon is typically performed when breast development is complete and final breast tissue volumes have been achieved. Treatment of athelia is similar to the nipple reconstruction procedures, with particular attention paid during reconstruction to the placement of the inframammary fold (i.e., the lower anatomical boundary of the breast) and re-creation of the nipple. The reconstructed nipple can be later tattooed to add color and to create the areola.

Inverted nipples can sometimes cause difficulty with breastfeeding, but treatment is rarely considered. Most of the time, skin-to-skin contact with the baby shortly after birth is desired to allow the baby to use its innate reflexes, and feeding in a laid-back position can improve breastfeeding outcomes. Some individuals prefer to use a breast pump just before feeding to temporarily reverse the nipple inversion or a reverse syringe device, with no needle attached, to help pull out the nipple. If the baby cannot attach properly, trying to bring out the nipple with one’s hands by pressing around the areola could also be helpful. Lastly, a nipple shield is recommended for babies with breastfeeding difficulties as it provides a more significant and firm point for the baby to latch on during the feed.  

What are the most important facts to know about nipple deformities?

Nipple deformities refer to any changes identified in the nipple and areola complex, including polythelia, nipple inversion, nipple retraction, and athelia. Usually, nipple deformities are congenital, but they can also present later in life, secondary to malignancy, post-surgical complications, inflammation, or infection. Most nipple deformities do not require treatment; however, plastic and reconstructive surgery could be considered, depending on the underlying cause. 

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Related links

Anatomy of the breast
Mammary gland histology
Anatomy clinical correlates: Breast

Resources for research and reference

AG, M. (2021, October 22). 6 tips for breastfeeding with inverted or flat nipples. Medela. Retrieved August 22, 2022, from https://www.medela.com.au/breastfeeding/blog/breastfeeding-tips/6-tips-breastfeeding-inverted-flat-nipples  

Caouette-Laberge, L., & Borsuk, D. (2013). Congenital anomalies of the breast. Seminars in plastic surgery, 27(1), 36–41. https://doi.org/10.1055/s-0033-1343995 

Kulkarni, D., & Dixon, J. M. (2012). Congenital Abnormalities of the Breast. Women’s Health, 75–88. https://doi.org/10.2217/WHE.11.84 

Marine, M. (2022, February 7). Inverted and flat nipples. La Leche League International. Retrieved August 22, 2022, from https://www.llli.org/breastfeeding-info/inverted-flat-nipples/