Inverted nipple correction sometimes requires an incision around the nipple or areola, so it cannot be described as scarless. What can be done is to limit the extent of the incision and use the nipple–areola junction so that the scar is less visible. And correction is not simply a matter of pulling the nipple out: the grade of inversion, the fibrous tissue beneath the nipple, plans for breastfeeding, the need to preserve ducts and nerves, and the risk of recurrence all shape the decision.
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How much scarring follows inverted nipple surgery?
Where skin is incised, some scarring is inevitable. The nipple and areola do, however, have a colour and texture transition, so the incision site and extent can be planned to keep the scar inconspicuous.
In practice, reducing incision length alone is less important than how much of the tissue causing the inversion must be released and how much support the nipple needs beneath. If a severe inversion is under-corrected in the interest of a smaller scar, the nipple may be drawn inward again.
So the realistic question is not whether a scarless operation exists, but how much the incision and scar can be minimised while achieving the correction that is needed.
Research on scar formation describes inflammation deep in the reticular dermis as the driver of thick scars. If you have had thick, raised scars before, mention it at consultation.[1]
Does the method change with the grade?
Yes. How easily the nipple everts and whether it stays out determines the extent of correction needed. Inverted nipples are usually graded by their appearance when the nipple is pulled by hand.
| Grade | Characteristic | What correction must consider |
|---|---|---|
| Mild | Everts easily and tends to stay out | Whether minimal tissue release is enough |
| Moderate | Everts but tends to invert again | Adequate release of the tethering fibrous tissue |
| Severe | Does not evert well even when pulled | Duct and fibrous tissue status, and recurrence risk |
The more severe the inversion, the stronger the tissue tethering the nipple inward, and tissue deficiency may coexist, so the surgical extent changes. Rather than applying one method to every inverted nipple, the grade, nipple shape and the proportion of areola to breast should be assessed together.
In a systematic review of 13 studies on benign inverted nipple treatment, recurrence was 0.6% with duct-preserving methods and 9.9% with methods that damage the ducts; the authors recommended considering duct-preserving techniques first.[2]
Read alsoNipple and areola procedures are covered in “Nipple and areola surgery: which method when size and shape are the concern?” (Korean).
Does breastfeeding planning affect the method?
If pregnancy and breastfeeding are planned, how much of the duct system can be preserved becomes an important criterion. Lactiferous ducts pass beneath the nipple, and in severe inversion the tethering tissue must be released adequately — which is where duct-preserving and duct-sacrificing approaches divide.
Duct-preserving correction aims to maintain the potential for future feeding, though preserving the ducts does not guarantee breastfeeding will be possible. Conversely, with very severe inversion, a finer judgement may be needed between the stability of correction and duct preservation.
If you plan to have children, tell your surgeon before surgery and confirm how the ducts will be handled.
Must scarring and recurrence be weighed together?
Correction must consider not only the scar but the chance of the nipple inverting again. Because the fibrous tissue and ducts tethering the nipple inward are involved, simply pulling the nipple out and fixing it may not be sufficient.
Where correction maximises duct preservation, the possibility of re-inversion must be considered according to grade and tissue state. Various duct-preserving and non-preserving techniques are in use, and no single method has been established as best for every patient.
Choosing a method therefore means looking at whether the projection holds stably and how much feeding function and sensation can be preserved, not only at how small the scar can be.
What must be checked before surgery?
First establish whether the present shape has been there for a long time or has appeared recently. Unlike congenital or long-standing inversion of both nipples, a previously normal nipple that has recently begun to invert on one side should not go straight to cosmetic correction — the breast should be assessed first. New, persistent unilateral inversion may require investigation to exclude underlying breast disease.
For long-standing inversion, the following are reviewed together:
- How easily the nipple everts when pulled by hand
- Whether the everted nipple stays out
- The amount of fibrous tissue beneath the nipple
- Plans for future pregnancy and breastfeeding
- The need to preserve nipple sensation
- Previous breast or nipple surgery
- Scarring tendency and skin condition
- The likelihood of recurrence after correction
The method should not be decided by scar size alone but by grade, functional preservation and recurrence risk together.
Inverted nipple correction: common myths and facts
| You may think… | In practice |
|---|---|
| "Inverted nipple surgery leaves a big scar." | Most are done through a small incision beneath the nipple, so the scar is not prominent. |
| "All inverted nipples are fixed the same way." | Grade determines whether ducts are preserved and which method is used. |
| "Once corrected, it can never invert again." | Some methods carry a recurrence risk, so how the nipple is fixed matters. |
In an inverted nipple consultation I look at how easily the nipple everts when pulled and whether it stays out. If it everts easily and holds, a simpler duct-preserving method is often enough.
Inverted nipple correction involves an incision, so it should not be sold as scarless — but the incision can be limited and placed at the nipple–areola junction to keep scarring inconspicuous. More important than scar size is the grade of inversion, the fibrous tissue beneath the nipple, plans for breastfeeding and the risk of recurrence. Duct-preserving methods recurred in 0.6% versus 9.9% for duct-sacrificing methods in a review of 13 studies, and any newly appeared one-sided inversion should be investigated before correction is considered.
🔬 The research behind this article
These are the international journal papers that support the content above. Select a title to open the abstract on PubMed.
- International Journal of Molecular Sciences 2017 — keloid and hypertrophic scar formationOgawa R. Keloid and Hypertrophic Scars Are the Result of Chronic Inflammation in the Reticular Dermis. Int J Mol Sci. 2017;18(3).Key: chronic inflammation in the reticular dermis drives thick scarsText [1] · PMID 28287424 · DOI
- The Breast 2016 — systematic review of 13 studies on benign inverted nippleHernandez Yenty QM, Jurgens WJ, van Zuijlen PP, de Vet HC, Verhaegen PD. Treatment of the benign inverted nipple: A systematic review and recommendations for future therapy. Breast. 2016;29:82-9.Key: recurrence 0.6% duct-preserving vs 9.9% duct-damagingText [2] · PMID 27476082 · DOI
🎬 Watch: Dr. Park Seong-Soo on video
Korean-language videos from BongBong Plastic Surgery's official channel and Dr. Park's channel, “Seongsu-ro Doctor”. Titles are translated for reference; selecting one opens YouTube.
- Inverted nipple surgery has a purpose beyond cosmeticsSeongsu-ro Doctor · 2018.05.29
- Can nipple reduction or inverted nipple correction be done with breast reduction?Seongsu-ro Doctor · 2021.08.27
Frequently asked questions
Does inverted nipple surgery leave no scar at all?
A. Where an incision is needed, a scar cannot be ruled out entirely. Using the nipple–areola junction and limiting the incision can minimise how visible the scar is.
Does a more severe inversion mean a bigger scar?
A. Not necessarily in proportion. Severe inversion may need fuller release of the tethering tissue or additional support beneath the nipple, which can change the method.
Can I breastfeed after inverted nipple surgery?
A. A duct-preserving method aims to maintain feeding potential, but this varies with grade and technique. If you plan to have children, tell your surgeon before surgery.
Can the nipple invert again after surgery?
A. It can. Recurrence risk varies with grade, tissue state and method, so the technique and its recurrence rate should be explained beforehand.
One nipple has suddenly inverted — can I have correction straight away?
A. The breast should be assessed first. New unilateral inversion, especially with a lump, skin change or bloody discharge, needs the cause established before correction is decided.
📖 References
Select a [number] in the text to jump to the source, and ↩ to return. Only papers whose title, journal and year were verified on PubMed are included.
- Ogawa R. Keloid and Hypertrophic Scars Are the Result of Chronic Inflammation in the Reticular Dermis. Int J Mol Sci. 2017;18(3). — International Journal of Molecular Sciences 2017 — keloid and hypertrophic scar formation. ↩
- Hernandez Yenty QM, Jurgens WJ, van Zuijlen PP, de Vet HC, Verhaegen PD. Treatment of the benign inverted nipple: A systematic review and recommendations for future therapy. Breast. 2016;29:82-9. — The Breast 2016 — systematic review of 13 studies on benign inverted nipple. ↩
BongBong Plastic Surgery · Dr. Park Seong-Soo, Medical Director
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