The drawn nipple

This pathology is found in every tenth woman. And, as a rule, the flat or drawn nipple most strongly excites women, either as an element of aesthetic imperfection, or when lactation begins after birth and the young mother faces the problem of how to feed the newborn. In this case, mammologists distinguish between two types of this anatomical abnormality: when the retracted nipple after hard manual stimulation hardens and becomes convex and the inverting option is a truly retracted state. This article for the most part sets itself the task of highlighting a heavier second case of pathology.

Causes of the drawn nipple

Many women, faced with this problem, acquire an inferiority complex, asking the question, why did this happen? The reasons for this clinical picture can be different.

• Heredity.
• Incorrect selection of a bra. Especially this occurs if a woman wants to visually reduce the breast, using a known smaller size than necessary. Or an incorrect selection of the size and model of the bra.
• Diseases affecting the breast tissue.
• Congenital pathology of the development of connective fibers holding the milk ducts.
• Violation of the period of sexual development of the girl - insufficient formation of the milk ducts and mammary glands.
• Tumor formation (both benign and malignant).

These causes the nipple to be drawn into the areola. This situation not only causes a woman aesthetic discomfort, but is also dangerous. It can become a risk factor for the development of the inflammatory process in the chest - mastitis.

[1], [2], [3]

Symptoms of the drawn nipple

To more confidently talk about the type of nipple, you should conduct a simple test. Its essence is as follows: take the thumb and forefinger of the nipple at its base and gently squeeze. If, but even more, moved out - the natural state of the norm, and if left inside - retracted.

The main symptoms of the retracted nipple are quite visual - the nipple is always on the same level as the areola, or completely "drowned" inside.

This anatomical picture refers to anomalies and requires expert advice. In this case, it will be a doctor - mammologist.

To date, doctors divide this pathology into two types:

• Hiding. When the nipple sufficiently freely swells with manual stimulation and does not cause great inconvenience when feeding the baby.
• Inverted. The situation when the nipple is always inside the areola. This situation does not change with manual stimulation. It is this pathology that gives the woman the greatest troubles and problems, both aesthetic and functional.

Women who have an abnormality of the structure of the breast, namely the version of the drawn nipple, often complain of pain in this area of the body. Basically, similar symptoms accompany them during the feeding of a newborn baby with breast milk.

Due to its incorrect structure, such a nipple does not allow the baby to grab it normally. The child, as he can, tries to do this, but with his actions he causes the mother pain. Another reason for the pain in this situation is the misapplication of the "nozzle" - the artificial nipple.

Therefore, if the nipple is involved and hurts, it is advisable to consult a specialist. Perhaps the cause of discomfort is one of the above reasons, and perhaps just the wrong young mother selected a pose for feeding her baby.

[4]

Complications and consequences

A retracted nipple often creates a ghost aesthetic discomfort, developing an inferiority complex.

Over time, the consequences of this deviation from the norm lead to other problems. And with the most significant of these, a woman faces directly after childbirth.

[5], [6], [7], [8], [9], [10]

Complications

This deviation refers to the pathology of psychological, cosmetic, and, most importantly, physiological character. If we talk about the health consequences of the patient, then it does not threaten any pathological changes.

But there are clinical situations when a woman is offered a correction of a pathological defect through surgical intervention. Going to surgery, the patient should be ready for the fact that in the post-operation period complications are possible that will have to be stopped.

To such consequences it is possible to carry:

• Puffiness near the operating tissues.
• Soreness at rest or touching.
• Skin irritation.
• Allergic reaction to the drug or material.
• Infection with subsequent wound suppuration.
• Development of hematoma.
• Scar formation.

If the operation is performed correctly, these symptoms will pass quickly enough.

[11], [12], [13], [14], [15], [16], [17]

Diagnostics of the drawn nipple

The drawn nipple is perfectly visualized. And this is the first thing that catches your eye when examining the mammary glands. The subsequent diagnosis of this problem may consist in the fact that the doctor prescribes additional laboratory tests and instrumental diagnostics.

• Mandatory blood and urine analysis.
• Visual examination of mammary glands and areas of localization of nearby lymph nodes. In this case it is the axillary zone.
• Cytology of the material taken from the surface of the nipple.
• Radiography.
• Ultrasound examination of the region of interest.
• If necessary, X-ray diagnosis of soft tissues of the axillary zone.

Instrumental diagnostics

• Ultrasound examination of the mammary glands (ultrasound).
• Color Doppler mapping (CDC).

If necessary, an additional examination may be prescribed. It can be:

• Laser mammography.
• Magnetic resonance imaging.
• When planning surgical treatment a woman is suggested to go (if there is such a possibility) a panoramic sonography.
• Multislice computed tomography of mammary glands with contrast intravenous enhancement.
• Aspiration biopsy performed during monitoring, performed by means of X-ray and ultrasound techniques.
• Three-dimensional ultrasonography - an ultrasound examination in 3D format.
• Radionuclide diagnosis - analysis of parameters obtained after the introduction of special biochemical or chemical compounds into the patient's body.
• Examination of oncomarkers (in case of suspected cancer of the breast).
• Stump phlebography, with suspected involvement in axillary lymph nodes.

[18], [19], [20], [21]

Treatment of the drawn nipple

There are two main methods of treatment of a retracted nipple: surgical and non-surgical. Depending on the nature of the pathology, the normalization of the nipple's shape can take place through radical intervention in the structure of the nipple and, by plastic surgery, giving it new forms.

Nonsurgical therapy includes a number of techniques. It can be:

• Treatment by performing a certain set of exercises.
• Correction of the defect of the retracted nipple with a vacuum nozzle in the form of a bowl.
• Use of lining on the nipple.

The choice of the option largely depends on the woman herself. Before deciding on an operation, she must answer herself to the following question: is she planning a pregnancy and feeding a newborn baby? If so, surgery makes sense. To the same result, a woman can be led by her desire to correct a defect for the sake of aesthetic correction.

What to do with a retracted nipple?

As the statistics show, about ten percent of women face the problem we are considering in this article. Therefore, the question of what to do with a retracted nipple, for them is quite relevant and requires the fastest explanation.

As already mentioned above, before trying to solve the problem on their own, it is not superfluous to seek advice from a specialist (a doctor - a mammologist). He, having conducted appropriate surveys, differentiates the problem and suggests ways of solving it.

If there are indications, the woman plans a pregnancy and wants to feed her baby herself with breast milk, while her health allows it, you can use the surgical plasty of the nipple. This radical method will solve the problem once and for all.

Also, a specialist can offer the patient the most suitable method for her case of non-surgical resolution of pathological deviation. She will be offered a set of special exercises or the use of lining specially designed for such pathology.

The complex of exercises basically comes down to manual stimulation of the nipple with phalanxes of hands. These actions are aimed at forming an adequate reaction of the nipple to irritation. This technique is most effective in case of false convexity, when stimulation results in the nipple swelling and occupying a place, rising above the ring of areola.

The essence of the exercise is in rhythmic compression by two fingers (index and large) of the base of the nipple, first inward, and then making rhythmic movements, as if stretching the nipple. This procedure should be performed for several minutes two to three times a day for two to three months.

It should be warned that this stimulation is strictly unacceptable at a time when a woman is pregnant and is in the first or second trimester. Since stimulation of the nipple contributes to an increase in the tone of the uterus, which can cause premature birth, and as a result - the loss of a child and the termination of pregnancy.

Operative treatment

One of the methods that help to resolve the existing anatomical deviation is surgical treatment, which the doctor can resort to either at the request of the patient or at the doctor's insistence if this pathology becomes an obstacle for the woman in terms of feeding her baby with the breast. In any case, there should be a voluntary consent of the patient and the absence of contraindications to surgical intervention.

This technique makes it possible to solve this issue radically and quickly enough. To date, there are several methods of surgical intervention. The choice largely depends on the answer to the question whether the woman plans to continue to give birth and to feed the newborn with breast milk.

To understand the essence of surgical treatment, it is not superfluous to recall the structure of the zone of interest to us. Approximately 25 milky ducts have their exit on the nipple surface. At the same time they are supported and connected with each other by strands of connective fibers, the other end of which is fixed in the deep layers of the mammary gland. If these connecting fibers have a size less than necessary, and the picture considered in this article is obtained.

The simplest variant is the intersection of the milk ducts, which, having a length less than the prescribed one or suffering from a loss of elasticity, are in tension, do not allow the pacifier to rise above the areola.

The second operation makes it possible to keep the milk ducts intact.

The operation that preserves the milk ducts can take place under the action of both general and local anesthesia. In this case, organ-preserving surgical intervention can also be carried out in two ways:

• When the correction is only exposed directly to the nipple and areola.
• Parallel with the manipulations of the first item, the surgeon - mammologist is also mammoplasty. That is, lifting, increasing or decreasing breast size is performed.

At the base of the areola, a small dissection (up to 1 cm in size) is made, through which, under the control of a microscope, a specialist performs the necessary manipulations. Usually this procedure takes about an hour.

The consequences of surgery in the postoperative period may be:

• The appearance of a hematoma.
• Puffiness of the operated site.
• Decreased sensitivity of the nipple.

But usually during the first week after the operation, puffiness and blueing pass, and sensitivity is restored.

During the following month, the woman who underwent the operation should take care of herself:

• It should not be allowed to raise a lot of weight and high physical exertion.
• Do not wear tight underwear.
• Prefer natural materials in clothes and bed linen.
• Exclude visits to swimming pools, solariums, open water bodies, sunbathing in nature.

The consequences of such a surgical intervention remain virtually invisible.

Correction of retracted nipples

Modern medicine is ready to offer women who have an anatomical defect of the breast in the form of a retracted nipple, a non-surgical solution to the problem. In this vein, physicians can suggest a number of devices, thanks to which correction of the drawn nipples takes place. These methods include the stimulation of the nipple with a vacuum, as well as the use of special corrective caps that make up for the missing volume of the nipple.

[22], [23], [24], [25]

Corrector of retracted nipples

One of the devices that allows to partially or completely solve the problem during the feeding of the baby is the corrector of the drawn nipples. This device is a modifier, in form repeating the areola and the nipple itself. This device is used during lactation.

Before feeding the woman fixes the cap - the corrector on the chest. It prevents the nipple from being drawn in during the feeding period of the newborn. In this case, the correction cap plays the role of protection against formation on the nipple and nearby tissues of the cracks.

The essence of the method in compulsory stretching to the natural size of the ducts of the breast. This allows you to remove the problem of feeding and makes it easy to adjust lactation.

Vacuum nozzles for retracted nipples

This device was developed by a plastic surgeon, Englishman Douglas Mac George. Vacuum nozzles for retracted nipples are becoming more popular today among women facing this problem.

Produced from hypoallergenic material, which is silicone, the vacuum nozzle is easy to use. But the effectiveness of its application varies from case to case. If the nipple falls into the areola, while taking stimulation takes a natural place, then this technique, with regular application, after three to four weeks will solve the problem and return the nipple to its normal position.

If the nipple is pathologically involved, then such a significant result is not expected, but its use will give an opportunity, and in this case, to normalize the feeding.

The mechanism of action of the proof-reader is simple and it is based on the phenomenon of vacuum. A specially made cap is worn on the nipple. Using a non-return valve, a syringe is connected to it, by means of which air is evacuated from the inner region, creating a vacuum in this zone. After the syringe is disconnected, the discharge is maintained by the non-return valve. Under the influence of vacuum, the drawn nipple stretches, acquiring a natural form.

If you wear this device every day for eight hours, then after three to four weeks the nipple begins to keep its natural form on its own. This result is achieved by soft and dosed stretching of the tissue structures of the milk ducts that hold the nipple in a certain anomalous position. The use of this device does not cause any significant negative impact on the basic functions of the breast.

But it is worth noting that this result is possible only in case of a false nipple. If a woman is diagnosed with a truly drawn nipple, this method will not lead to significant changes in the situation.

Vacuum nozzles for drawn nipples on the shelves of modern pharmacies today are represented by various modified series, allowing the woman to choose the model that suits her most fully.

The correct form of the nipple is usually worn inside the bra cups for a minimum of eight hours (during the day and / or at night).

Clinical trials have shown the high efficiency of this method of reducing the problem.

How to feed the child when the nipples are drawn?

If a woman has a retracted nipple, it is desirable to correct it before the pregnancy is planned. If such "treatment" was not carried out, then over time the question arises, how to feed the child with the nipples drawn in?

In this situation, experts advise preparing nipples for the period of lactation, starting from the 38th week of pregnancy. Preparation of drawn nipples for feeding a child consists in a whole complex of measures that allow solving the problem before the moment of lactation.

These methods include massage or as it is also called "special exercises for the normalization of the involved nipple." The essence of the exercise is in rhythmic compression by two fingers (index and large) of the base of the nipple, first inward, and then making rhythmic movements, as if stretching the nipple. This procedure should be performed for several minutes (no more than ten) two to three times a day for two to three months. When carrying out this exercise, it is advisable to apply a thin layer of lanolin or massage oil on the areola. This will protect the sensitive skin of the breast from physical damage and will correctly perform the exercise.

Feeding with retracted nipples

It is worth immediately preparing that the first attachment to the chest will be problematic.

The woman will have to have patience and work hard to adjust in such a situation lactation and feeding.

Will try to figure out what to do in this case, in order to solve the problem quickly.

• The first thing that can be advised to such women is the position when feeding. During the feeding period, the young mother should take the baby on the handles, slowly walk around the room. Such a course will help to develop a sucking reflex in a newborn. After all, this position is familiar to him, he felt it for nine months, being in the womb of his mother.
• You should choose the correct feeding posture. This applies to both the child and the mother. The baby's head should be positioned so that his mouth is parallel to the nipple. To achieve this, the woman in childbirth should keep the baby on one hand and the breast supported on the second.
• Before you start feeding, you need to get advice on how to properly hold your fingers on your chest. Four phalanges should support the chest from below, and the phalanx of the thumb fixes the breast from above.
• When feeding standing, it is desirable to protect the baby. To do this, it should be swaddled or placed in a sling. In such a situation, the baby is deprived of the opportunity to actively move, which will somewhat facilitate the procedure for feeding.
• If the first time did not work for the baby to take a nipple in his mouth. Do not force him to stuff it. Such "violence" will only repel the baby, fixing negative perception. It is worth trying to slightly irritate the baby, leading a nipple on his lips. Reflectively, the child joins the game and tries to grab the nipple.
• In order for the baby at first it was not so difficult to grip the nipple with her lips, it is necessary before each feeding, to express a small amount of breast milk. This will relieve tension in the chest and make it softer and supple. In this situation, the nipple must be presented together with the areola.

To help yourself with feeding when your nipples are drawn in, a woman should consult her doctor, who will help her pick up a device that will help her to cope with the problem more easily. The benefit of the modern market is ready to offer a fairly good choice of models, like correcting caps (silicone linings), and special vacuum nozzles.

Piercing on the drawn nipples

The modern piercing has found a second wind. Where only, and on which parts of the body, do not have to see these "works of art". But in the light of the pathology we are considering, we will try to highlight it from this side.

In social networks, multiple respondents who have had to deal with this problem are interested in whether it is possible to do piercing on the drawn nipples? And whether this procedure can correct the situation by stretching the nipple and making it naturally normal.

As experience has shown, in these assumptions there is a rational grain. In some cases, the piercing put in the nipple, to some extent, replaces the vacuum, "pulling" the nipple to a normal position. And it works.

But even without looking back to do yourself this procedure to solve the problem, should not, since it is still traumatizing the nipple with an open wound. And if the puncture is made not by a professional and in unsanitary conditions, then no such "treatment" will lead to anything good.

The procedure itself, as already mentioned, should be carried out under sterile conditions by a professional.

In a number of cases, it is not technically possible to make piercing in the nipple, and precisely because the nipple is drawn. So it's not that easy.

Prevention

To date, there are no specific measures that can prevent the development of a retracted nipple. This prevention is reduced to the timely detection, diagnosis and treatment of diseases and pathological anatomical abnormalities that can lead a woman's breast to the pathology associated with a change in the position of the nipple.

[26], [27]

Forecast

In general, the prognosis of the drawn nipple is favorable.

[28]