Inverted Nipples and Breast Cancer: What You Need to Know
Nipples come in various sizes, colors, textures, and shapes. You may have nipples that point up or down, outward or inward, or they may lie flat against your areola (the slightly darker circle of skin surrounding your nipple). A nipple that points inward is called an inverted nipple.
Having an inverted nipple or two is common, with about 10-20% of people having them. “Many women — and even men — experience some degree of nipple inversion,” says Meegan Gruber, MD, PhD, a plastic surgeon in Florida.
Typically, having inverted nipples isn’t a cause for concern. But a sudden change in your nipple from outward to inward could be a sign of an underlying medical condition, such as breast cancer.
What causes inverted nipples?
Some people are born with inverted nipples, caused by the nipples not fully forming before birth. Others develop inverted nipples over time. Here are a few reasons why you might develop inverted nipples:
Aging: Your milk ducts (the area of the breast that carries milk to the nipple) may shorten and widen before entering menopause due to a decrease in estrogen levels. The tightening of the milk ducts can cause the nipple to pull inward, causing it to flatten or invert.
Pregnancy: It’s common for nipples and breasts to change during pregnancy. Hormonal shifts can lead to changes in breast tissue around the nipple and milk ducts. Sometimes, this can cause the milk ducts to pull the nipple inwards as the breast grows.
Breast engorgement: Your nipples can become flattened or inverted as your breasts become filled with milk after you’ve given birth.
Breastfeeding: Your nipples may become inverted or flattened as you breastfeed due to the milk production in your breasts.
Infections: Certain infections, such as infection of the mammary gland (mastitis) or when the milk duct widens and thickens (mammary duct ectasia), may cause your nipples to invert.
Benign breast disease: Benign or noncancerous breast disease can cause lumps and other changes to your breasts, including inverted nipples.
Fat necrosis: When fat in the breast becomes damaged — due to a breast biopsy, radiation, or breast reconstruction surgery — it may cause inverted nipples.
Injuries: If you’ve had breast surgery, your nipples may become inverted.
Sudden weight loss: Rapid weight loss may result in less fatty tissue behind the nipples, making them sink in or invert.
While rare, inverted nipples can be a symptom of breast cancer. “Cancer can cause your nipples to invert if the tumor involves the tissue that attaches to the nipple or involves the nipple itself,” says Dhivya Srinivasa, MD, FACS. Srinivasa is a microsurgeon who specializes in breast reconstruction and founder of The Institute for Advanced Breast Cancer Reconstruction in California and Texas.
One breast cancer that affects the nipple is Paget disease of the breast. This rare breast cancer starts in the nipple before spreading to the surrounding areola. In addition to an inverted or flattened nipple, symptoms of the disease include:
redness, itching, or tingling in the nipple and areola
crusty, flaky, or thickened skin in or around the nipple
yellowish or bloody discharge from the nipple
Inflammatory breast cancer is another rare cancer that may cause inverted nipples. This cancer often causes the breast to appear swollen and feel heavy. Other symptoms may include:
skin discoloration on the affected breast
dimpling, pitting, or ridges on the affected breast’s skin
hives, welts, or other breast skin changes
unusual warmth of the affected breast
tenderness, pain, aching, burning, or itchiness of the affected breast
When to see a doctor
If you’ve had inverted nipples for most of your life (also called congenital inversion), Gruber advises that a trip to the doctor shouldn’t be necessary. However, if your nipple becomes inverted suddenly and you’re not pregnant or postpartum, or you notice other symptoms, such as pain, discharge, or a lump, it's a good idea to see a doctor. “Any sudden change in nipple appearance can be a red flag, so it's always better to err on the side of caution,” Gruber says.
How inverted nipples are diagnosed
To determine the cause of your inverted nipple (or nipples), your primary doctor or gynecologist will likely start with a physical exam to check for abnormalities like lumps or skin changes, Gruber says.
According to Srinivasa, your healthcare provider may also do the following tests:
breast ultrasound: an imaging test that collects pictures of the inside of your breast
ductography: a test that uses X-rays to create pictures of the milk ducts in your breast
mammogram: an X-ray picture of your breast
MRI (magnetic resonance imagery): another imaging test that uses radio waves to collect pictures of your breast
A breast biopsy may be performed to rule out breast cancer if your healthcare provider finds something abnormal in any of the above tests. For the procedure, a doctor will use a needle to remove breast tissue or fluid to check for cancer cells.
Treatment
Treatment for inverted nipples varies based on the underlying cause. “For those with congenital inversion who wish to correct it for cosmetic reasons or to facilitate breastfeeding, surgical correction can be performed,” says Gruber. “This involves releasing the tightened ducts beneath the nipple to allow it to project outward.” She also explains that manual nipple techniques, nipple shields, or suction devices may be helpful for mild cases of inverted nipples.
If an underlying condition is found to be the cause of inverted nipples, Gruber says that the focus would be on treating the condition itself rather than nipple inversion.
If your primary care doctor believes you have breast cancer based on the results of the physical exam, they can refer you to a surgical oncologist or breast surgeon. This physician will administer additional testing to confirm the presence of breast cancer and discuss treatment options. Your treatment will depend on what type and stage of breast cancer you have.
If you have breast cancer that’s causing inverted nipples, your treatment will focus on treating the cancer. Possible breast cancer treatment may include the following:
surgery: a procedure to remove as much of the cancerous tissue as possible
immunotherapy: a treatment that works with your immune system to help it attack cancer cells or reduce side effects from other cancer treatments
chemotherapy: a drug treatment that targets and kills breast cancer cells
hormonal therapy: a treatment that blocks breast cancer cells from getting the hormones they need to grow and spread
radiation therapy: a treatment that uses high-energy rays to kill breast cancer cells
— Last updated on February 22, 2025 at 9:09 PM