| nipple | |
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| Other names | invaginated nipple |
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| Inverted versus normal nipple | |
| Specialty | Gynecology |
An inverted nipple (occasionally invaginated nipple) is a condition where the nipple, instead of pointing outward, is retracted into the breast. In some cases, the nipple will be temporarily protruded if stimulated. Both women and men can have inverted nipples.
The most common causes of nipple inversion include:
Most common nipple variations that women are born with are caused by short ducts or a wide areola muscle sphincter.
Inverted nipples can also occur after sudden and major weight loss.
The three grades of inverted nipples are defined on how easily the nipple may be protracted and the degree of fibrosis existent in the breast, as well as the damage it has caused on the milk ducts.
Inverted nipple grade 1 refers to nipples that can easily be pulled out, by using finger pressure around the areola. The grade-1 inverted nipple maintains its projections and rarely retracts. Also, grade-1 inverted nipples may occasionally pop up without manipulation or pressure. [1] Milk ducts are usually not compromised and breast feeding is possible. These are "shy nipples". It is believed to have minimal or no fibrosis. There is no soft-tissue deficiency of the nipple. The lactiferous duct should be normal without any retraction.[ medical citation needed ]
Inverted nipple grade 2 is the nipple which can be pulled out, though not as easily as the grade 1, but which retracts after pressure is released. Breast feeding is usually possible, though it is more likely to be hard to get the baby to latch comfortably in the first weeks after birth; extra help may be needed. Grade 2 nipples have a moderate degree of fibrosis. The lactiferous ducts are mildly retracted, but do not need to be cut for the release of fibrosis. On histological examination, these nipples have rich collagenous stromata with numerous bundles of smooth muscle.
Inverted nipple grade 3 describes a severely inverted and retracted nipple which can rarely be pulled out physically and which requires surgery to be protracted. Milk ducts are often constricted, and breast feeding is difficult, but not necessarily impossible. With good preparation and help, babies often can drink at the breast, and milk production is not affected; after breastfeeding, nipples often are less or no longer inverted. Women with grade-3 inverted nipples may also struggle with infections, rashes, or problems with nipple hygiene. The fibrosis is remarkable and lactiferous ducts are short and severely retracted. The bulk of soft tissue is markedly insufficient in the nipple. Histologically, atrophic terminal duct lobular units and severe fibrosis are seen.
Women with inverted nipples may find that their nipples protract (come out) temporarily or permanently during pregnancy, or as a result of breastfeeding. Most women with inverted nipples who give birth are able to breastfeed without complication, but inexperienced mothers may experience higher than average pain and soreness when initially attempting to breastfeed. When a mother uses proper breastfeeding technique, the infant latches onto the areola, not the nipple, so women with inverted nipples are actually able to breastfeed without any problem. An infant that latches on well may be able to slush out an inverted nipple. The use of a breast pump or other suction device immediately before a feeding may help to draw out inverted nipples. A hospital grade electric pump may be used for this purpose. Some women also find that using a nipple shield can help facilitate breastfeeding. Frequent stimulation such as sexual intercourse and foreplay (such as nipple sucking) also helps the nipple protract.
Other strategies for protracting inverted nipples include regularly stimulating the nipples to a protruding state, in an attempt to gradually loosen the nipple tissue. Some sex toys designed for nipple stimulation, such as suction cups or clamps, may also cause inverted nipples to protract or stay protracted longer. Some special devices are specifically designed to draw out inverted nipples, or a home-made nipple protractor can be constructed out of a 10-ml disposable syringe. These methods are often used in preparation for breastfeeding, which can sometimes cause inverted nipples to become protracted permanently.
Two methods which are now discouraged are breast shells and the Hoffman technique. Breast shells may be used to apply gentle constant pressure to the areola to try to break any adhesions under the skin that are preventing the nipple from being drawn out. The shells are worn inside the bra. The Hoffman technique is a nipple-stretching exercise that may help loosen the adhesions at the base of the nipple when performed several times a day. Although both techniques are heavily promoted, a 1992 study found that not only do shells and the Hoffman technique not promote more successful breastfeeding, but they may also actually disrupt it. [2]
The breast is one of two prominences located on the upper ventral region of the torso among humans and other primates. Both sexes develop breasts from the same embryological tissues. The relative size and development of the breasts is a major secondary sex distinction between males and females.
The nipple is a raised region of tissue on the surface of the breast from which, in females, milk leaves the breast through the lactiferous ducts to breastfeed an infant. The milk can flow through the nipple passively or it can be ejected by smooth muscle contractions that occur along with the ductal system. Male mammals also have nipples but without the same level of function, and often surrounded by body hair.
The human areola is the pigmented area on the breast around the nipple. Areola, more generally, is a small circular area on the body with a different histology from the surrounding tissue, or other small circular areas such as an inflamed region of skin.
Breast engorgement occurs in the mammary glands due to expansion and pressure exerted by the synthesis and storage of breast milk. It is also a main factor in altering the ability of the infant to latch-on. Engorgement changes the shape and curvature of the nipple region by making the breast inflexible, flat, hard, and swollen. The nipples on an engorged breast are flat or inverted. Sometimes it may lead to striae on nipples, mainly a preceding symptom of septation mastitis.
A nipple piercing is a type of body piercing, centered usually at the base of the nipple. It can be pierced at any angle but is usually done horizontally or, less often, vertically. It is also possible to place multiple piercings on top of one another.
Lactiferous ducts are ducts that converge and form a branched system connecting the nipple to the lobules of the mammary gland. When lactogenesis occurs, under the influence of hormones, the milk is moved to the nipple by the action of smooth muscle contractions along the ductal system to the tip of the nipple. They are also referred to as galactophores, galactophorous ducts, mammary ducts, mamillary ducts or milk ducts.
A nipple shield is a nipple-shaped sheath worn over the areola and nipple during breastfeeding. Modern nipple shields are made of soft, thin, flexible silicone and have holes at the end of the nipple section to allow the breast milk to pass through.
Erotic lactation is sexual arousal by breastfeeding on a woman's breast. Depending on the context, the practice can also be referred to as adult suckling, adult nursing, and adult breastfeeding. Practitioners sometimes refer to themselves as being in an adult nursing relationship (ANR). Two persons in an exclusive relationship can be called a nursing couple.
Breast shells are hollow, lightweight plastic disks worn inside the brassiere to help correct flat or inverted nipples either in preparation for or during breastfeeding. Also known as milk cups, breast cups, breast shields, or Woolwich shields, they can also be used to ease sensitive nipples or collect milk when the baby has not finished the teat. Breast shells function by applying gentle but firm pressure to the region surrounding the nipple to stretch underlying adhesions and draw out the nipple. Nipple shields may be confused with breast shells, but shields are intended for use during the act of breastfeeding, whereas breast shells are worn in preparation for or after breastfeeding.
Breastfeeding difficulties refers to problems that arise from breastfeeding, the feeding of an infant or young child with milk from a woman's breasts. Although babies have a sucking reflex that enables them to suck and swallow milk, and human breast milk is usually the best source of nourishment for human infants, there are circumstances under which breastfeeding can be problematic, or even in rare instances, contraindicated.
Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be pumped and fed to the infant. The World Health Organization (WHO) recommends that breastfeeding begin within the first hour of a baby's life and continue as often and as much as the baby wants. Health organizations, including the WHO, recommend breastfeeding exclusively for six months. This means that no other foods or drinks, other than vitamin D, are typically given. The WHO recommends exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond. Of the 135 million babies born every year, only 42% are breastfed within the first hour of life, only 38% of mothers practice exclusive breastfeeding during the first six months, and 58% of mothers continue breastfeeding up to the age of two years and beyond.
Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process naturally occurs with all sexually mature female mammals, although it may predate mammals. The process of feeding milk in all female creatures is called nursing, and in humans it is also called breastfeeding. Newborn infants often produce some milk from their own breast tissue, known colloquially as witch's milk.
Microdochectomy is the surgical removal (excision) of a lactiferous duct. A mere incision of a mammary duct is called microdochotomy.
Cracked nipple is a condition that can occur in breastfeeding women as a result of a number of possible causes. Developing a cracked nipple can result in soreness, dryness or irritation to, or bleeding of, one or both nipples during breastfeeding. The mother with a cracked nipple can have severe nipple pain when the baby is nursing. This severe pain is a disincentive for continued breastfeeding. The crack can appear as a cut across the tip of the nipple and may extend to its base. Cracked nipple can develop after the birth of the infant and is managed with pharmacological and nonpharmacological treatment.
A blocked milk duct is a blockage of one or more ducts carrying milk to the nipple for the purpose of breastfeeding an infant that can cause mastitis. The symptoms are a tender, localised lump in one breast, with redness in the skin over the lump. The cause of a blocked milk duct is the failure to remove milk from part of the breast. This may be due to infrequent breastfeeding, poor attachment, tight clothing or trauma to the breast. Sometimes the duct to one part of the breast is blocked by thickened milk. A blocked milk duct can be managed by improving the removal of milk and correcting the underlying cause.
Latch refers to how the baby fastens onto the breast while breastfeeding. A good latch promotes high milk flow and minimizes nipple discomfort for the mother, whereas poor latch results in poor milk transfer to the baby and can quickly lead to sore and cracked nipples. In a good latch, both the nipple and a large portion of the areola are in the baby's mouth.
A nipple bleb is a blister on the nipple that can be filled with serous or other fluid. It may be pink or light yellow. It is thin-walled and may appear as a small blister, more than 5 mm in diameter. It can also be referred to as a bulla. Some clinicians may also include milk blisters as a type of bleb. In addition, a blocked Montgomery gland may also be called a nipple bleb though its cause is different than a milk or serous-filled bleb on the nipple. In some cases the bleb may be associated with an adjacent blocked sebaceous cyst.
In breastfeeding women, low milk supply, also known as lactation insufficiency, insufficient milk syndrome, agalactia, agalactorrhea, hypogalactia or hypogalactorrhea, is the production of breast milk in daily volumes that do not fully meet the nutritional needs of her infant.
Nipple pain is a common symptom of pain at the nipple that occurs in women during breastfeeding after childbirth. The pain shows the highest intensity during the third to the seventh day postpartum and becomes most severe on the third day postpartum.
Hand expression of breast milk is a technique used by lactating mothers to express milk using their hands. It is an ancient practice that has been used by women across the world for centuries. Hand expression has gained renewed interest in recent years due to its affordability, portability, and effectiveness. It is an important tool for breastfeeding mothers, especially those who are unable to afford or access breast pumps.
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