It is common for this inverted nipple operation to be performed taking advantage of another major breast surgery (augmentation mammoplasty or breast augmentation;  mastopexy or breast lift;  reduction mammoplasty or breast reduction), although only the surgical procedure of inverted nipples can be performed.

It is not easy to classify nipples by their appearance. They vary markedly in size, shape, texture, symmetry, color, and relationship to the areola and the size of the breast. We would define a normal nipple as one that protrudes (that is, moves forward or protrudes) a few millimeters above the areola, protruding further by stimulation by heat or touch. Nipples that appear in areas that are not usual are known as ectopic (usual in cases of polythelia or supernumerary nipples). Otherwise, the total absence of the nipple or athelia can occur.

We speak of a pedunculated nipple, when it is thinner in its implantation area. When it is artificially modified or altered, by piercings, surgeries, etc., we call it a reformed nipple. If it is very prominent, long, projecting, or large, we know it as  hypertrophic nipple. When it evolves in two segments, communicated or not, we know them as bifid or duplicate nipples, respectively.

By flattened or flat nipple we understand that nipple that, in relaxed conditions, practically does not protrude from the rest of the breast, although if we stimulate it it can protrude, resembling a normal nipple. And the typical  tuberous breast, the bulging nipple, which often appears smaller than usual compared to her more prominent areola.

Thus we come to the type of nipple that is the subject of this article, the inverted nipple, also known as the umbilicated nipple. In this case, it is not that it does not protrude a lot or a little, but rather that it remains hidden inside your areola, remaining in an even more flat plane. deeper than this. Three grades are used in the medical classification, depending on the possibility of protrusion after stimulation or manipulation. Thus, in grade 3 or maximum, after stimulation the nipple does not manage to protrude at all; while in grade 1 or minimal, the nipple protrudes and remains protruded after being stimulated.

Inverted nipples are usually caused by shortening of the breast ducts or dense connective tissue that joins the areola and nipple to the mammary gland. We can carry out the surgical correction of this problem, preserving the sensitivity of the nipples in almost all cases.

When inverted nipples occur as a new condition in a patient who previously had normal nipples, or when staining occurs from them, a tumor cause should be ruled out.

There are surgeries aimed at correcting or modifying the appearance of the nipple, achieving greater harmony of the areola-nipple complex and the entire chest; while preserving the function of lactation if it has not taken place. It should be mentioned that, in some cases, the ability to breastfeed may be affected. On the other hand, as this surgery can be associated with other surgeries such as breast augmentation with a prosthesis, sometimes, in slight degrees, it is corrected or improved without touching it.

In cases of congenital absence of the nipple or athelia, plastic surgery will consist of reconstructing both the areola and the nipple, using the patient's cartilage. This operation can achieve a very satisfactory aesthetic result, although it should be noted that in this case the patient will not be able to breastfeed in the future.