Plastic Surgeon and Breast Reconstruction Specialist Dr. Constance Chen Offers Practical Tips about Inverted Nipples

Inverted nipples are a common and normal variation in nipple shape. Also called retracted nipples, inverted nipples turn inward toward the breast instead of protruding. They occur in either one or both breasts, in both men and women, and may be congenital – present from birth – or may develop later in life.

As many as 10% of women may have one or both nipples inverted. Inverted nipples are not generally a cause for concern and require treatment only if they interfere with breastfeeding, if there is an underlying medical condition that must be addressed, or to satisfy aesthetic preferences.

Dr. Constance M. Chen, Breast specialist and plastic surgeon

Nipple inversion may be permanent or temporary, with the nipples fluctuating between inverted and erect. Some women experience inversion during pregnancy even if their nipples weren’t inverted before. While nipple sensitivity varies from person to person, inverted nipples are not ordinarily less sensitive to stimulation than erect nipples.

There are different grades of nipple inversion that may help determine whether it will interfere with breastfeeding or if treatment is needed. At the lowest level of inversion, the nipple can be easily pulled out and may remain protruding for some time. At a moderate level, the nipple can be pulled out, but will retract when released. With the most severely inverted nipples, it may be difficult or impossible to pull the nipple out. The higher the level of inversion, the more likely breastfeeding is to be difficult or impossible.

Breastfeeding is often problem-free with inverted nipples by having the baby latch onto the entire areola. Also, inverted nipples sometimes protrude naturally during pregnancy and breastfeeding or can be made to protrude by stimulation. Devices such as a ‘nipple shield’ that helps the baby latch on or a ‘breast shield’ that helps the nipple protrude may be helpful.

There are several treatment options for inverted nipples, most of them temporary and all of which should be discussed with a doctor to determine the best solution for each individual. There are home exercises for drawing the nipple out as well as suction devices that achieve a similar result in some cases. Inverted nipples can also be surgically corrected.

“Surgical options try to preserve the milk ducts to enable breastfeeding, but sometimes the milk ducts will be divided. When the milk ducts are disrupted to correct an inverted nipple, future breastfeeding may be difficult or even impossible”, says Dr. Chen. In either case, the procedure, generally performed under local anesthesia, involves a very small incision under the nipple through which a fine instrument is used to detach the fibers and duct(s) that are holding the nipple in an inverted position. A suture placed beneath the nipple then keeps it in position.

While inverted nipples aren’t generally medically troublesome, particularly when present since birth or when occurring gradually, over several years, there are indications that require medical attention. Nipples that had been protruding but flatten or turn inward suddenly or in a short period of time should be brought to the attention of a doctor. Other symptoms that require medical examination include discharge, a lump or swelling of the nipple, dimpling or thickening of the skin, and redness or pain.

“Inverted nipples are one of the many normal variations in the breast”, says Dr. Chen. “Depending on the degree of inversion, they may be easily manipulated to enable breastfeeding and they may be made to protrude for some period of time. When they cause distress for any reason, surgical correction is usually minimally invasive. As with many such procedures, correction can have a positive effect on a woman’s physical and emotional well-being”.

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.

One Size Doesn’t Fit All: Finding the Right Bra for Every Breast Shape

No two breasts are alike. For many women, even her own two natural breasts may not quite match. It is normal to have breasts that are different sizes and even different shapes. Breasts come in many different shapes, all of them completely normal, but important to be aware of when shopping for a bra.

A properly fitted bra is important for all women, not just large-breasted women who suffer discomfort in their necks and backs when their bras don’t support them adequately. Every woman will be more comfortable and less restrained in her physical activity if she is wearing a properly fitted bra.

Dr. Constance M. Chen, Breast specialist and plastic surgeon

Breast shape is determined primarily by genetics, but influenced by several additional factors, weight chief among them. The breast tissue that isn’t made up of milk ducts is largely composed of fat cells that increase and decrease as weight is gained and lost, potentially changing the shape as well as the size of the breast. Other factors are the hormonal changes that accompany pregnancy and breastfeeding and the changes that are a natural consequence of aging as skin loses elasticity and as the composition of breast tissue changes to a higher concentration of fat, which is more prone to sagging. Most women find that the shape of their breasts changes more than once over the course of their lifetimes and with that change comes the realization that it may be time to retire the bra style worn for decades and get fitted for a new one.

Any catalog of breast shapes is only an approximation, Just as every woman is unique, her breast shape cannot be expected to conform to a picture or description. However, even having a general idea of the one or two shapes that match you best can make all the difference in making sure you get a bra that fits. These descriptions of breast shapes aren’t comprehensive but most women – with the aid of a mirror – should be able to get an idea of which ones come closest to her own.

Dr. Constance M. Chen, Breast specialist and plastic surgeon

Round breasts appear to be equally full at the top and bottom of the breast. Not many women have well-rounded breasts, but many bras are designed for this presumed shape and account for lots of poor fit. Tear drop breasts are also rounded but fuller at the bottom than at the top. Women who have lost weight may find that their breasts now reflect this shape as they have less roundness at the top.

  • Bell breasts are also fuller at the bottom, but narrower at the top and less rounded than tear drops.
  • East west breasts have nipples that point outward, away from each other.
  • Side set breasts have a wide space between them; close set breasts have very little space between them.
  • Slender breasts are narrow and long and have nipples that point downward.
  • Athletic breasts tend to be wide-set and more muscular with less breast tissue, correlating with an athletic body that is muscular with little fat.
  • Conical breasts are cone-shaped rather than round and are more common in small-breasted women.
  • Asymmetric breasts may have differences in size or shape.
  • Relaxed breasts have looser tissue and nipples that point downward, similar to slenders, but generally fuller; they are more common later in life.

“Many women wear a bra that does not fit properly, which can lead to discomfort,” says Dr. Chen. “The best way to be properly fitted for a bra is in a specialized shop with experienced bra fitters. But with or without expert help, understanding the shape of your breasts will help you get the right fit. When a bra fits properly, there will be no gapping and no overflow in the cups, the straps won’t slip or dig into your shoulders, and you should be able to slip two fingers under the band in the back. Remember that the shape of your breasts will affect which bra is right for you”.

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.

Why Do My Breasts Hurt? Understanding Causes of Breast Pain

Most women suffer some form of breast pain at some point in their lives. It may be mild or severe, constant or intermittent. It may be in the form of soreness, sharp burning pangs, or tightness. “Breast pain, or mastalgia, is usually straightforward to diagnose and treat”, says plastic surgeon and breast specialist Dr. Constance M. Chen. “While it is seldom a sign of something serious, pain that doesn’t go away after one or two menstrual cycles or that persists in women after menopause should be evaluated by a doctor”.

Most breast pain is cyclical – linked to hormonal fluctuation associated with the reproductive cycle. Women describe cyclical breast pain as the breasts feeling heavy, tender, swollen, and achy. It is caused by increases in estrogen and progesterone that occur before the menstrual period and cause the breasts to swell. Cyclical breast pain generally affects both breasts, intensifies in the week or two leading up to the menstrual period, then recedes. It most often affects women during their childbearing years and as they are approaching menopause. Breast tenderness can be eased with over-the-counter pain relievers and by reducing salt, fats, and caffeine in the diet. Birth control pills – or switching to a different formulation – can also help.

The breasts may remain tender during the first trimester of pregnancy in response to increased hormone levels and that continuing breast soreness often accompanies a missed menstrual period as an early sign of pregnancy.

Dr. Constance M. Chen

Fibrocystic breast disease, also triggered by hormones, is characterized by dense, lumpy breast tissue that may become painful in response to the monthly cycle. The lumps are fluid-filled cysts and can be clearly differentiated from more dangerous lumps composed of a solid mass of cells that may signify a benign or malignant tumor. Cysts may resolve on their own but any lump in the breast must be evaluated by a doctor via mammogram, ultrasound, or aspiration – drawing fluid from the cyst.

Non-cyclical breast pain — unrelated to reproductive hormones – most often occurs in one breast and in a localized area though the pain may spread throughout the breast. There are several causes:
Mastitis is most common in breast-feeding women (lactation mastitis) but can occur at any time. It is characterized by inflammation of the breast tissue that causes swelling, redness, pain, and warmth and sometimes fever and chills. During lactation, mastitis is usually caused by a blocked milk duct or by bacteria entering the breast through an opening in the skin or a cracked nipple. It is generally treated with antibiotics.

Injury to the breast can be from a previous surgery, from an accident, or from sports. There may be a sharp pain at the time of the trauma followed by tenderness for days or weeks. A doctor should be seen if pain doesn’t subside or if there is redness and warmth, which could indicate the presence of infection, if there is severe swelling, or if there is a bruise that doesn’t go away.

Support issues are most often experienced by women with large, heavy breasts but poor support can cause the ligaments to stretch and cause pain in breasts of any size, particularly after exercise. Pain may also affect the neck, back, and shoulders. A properly fitted, supportive bra should be worn at all times and a sports bra when exercising.

Medications can cause breast pain as a side effect. Hormonal therapies used in infertility treatment, birth control pills, and hormonal replacement after menopause can cause breast tenderness. Some psychiatric medications and those used for coronary disease can also have this effect.

Many women worry that breast pain might be a sign of breast cancer. While this is unusual, it’s not impossible. Inflammatory breast cancer, which accounts for 1%-5% of breast cancers does cause pain as well as redness, swelling, and thickened or dimpled skin. The important thing for women to know is that while most breast pain isn’t dangerous, any condition that doesn’t resolve over the course of the menstrual cycle or a week or two should be evaluated by a doctor. In the vast majority of cases, treatment will be rapid and effective.

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.

Breastfeeding Won’t Cause Your Breasts to Sag and Nine other Surprising Facts about Breasts

More than any other organ in the human body, the breast occupies a place in our social and cultural landscape well beyond its physiological function to nourish our offspring. “The soft tissue that we think of as a breast is actually a mammary gland, a complex system of fat cells and ducts that produce milk and deliver it to a baby via the nipple”, says plastic surgeon and breast specialist Dr. Constance M. Chen. 

As much attention as we pay to the size, shape and appearance of a woman’s breasts, there are many fascinating facts – both important and trivial – that most people don’t know about breasts. Here are just a few of them.

1.   Breast size is hereditary. Genetics do play a role in determining breast size but not necessarily as you’d expect and they don’t tell the whole story. We inherit half our genes from each parent, so your breasts may not resemble your mother’s, her mother’s, or her sister’s. Your father’s genes have a say. “Environmental factors also play a role”, says Dr. Chen, “especially weight. Breasts are partly made up of fatty tissue so as you gain and lose weight, your breast size will change”.
2.   Humans are the only primates with permanent breasts. All mammals have breasts and produce milk for their young but we are the only ones who develop breasts at puberty and keep them throughout our lives. Others are temporary, growing when needed to nurse then receding until needed again.
3.   The ancient Egyptians knew about breast cancer as far back as 1600 B.C. Writings on papyrus describe tumors consistent with modern descriptions of the disease. Over the following centuries, many causes were suggested – from imbalances of bodily fluids to compression from tight clothing – and treatments ranged from cauterization to opium to arsenic.
4.   You cannot exercise your way to bigger breasts. “Breasts are made of tissue, not muscle”. says Dr. Chen. “They may change in size with hormonal and weight changes. But even exercising the underlying chest muscles won’t increase the size of your breasts any more than creams or lotions will”.
5.   Some animals get breast cancer. It is more common in dogs – and in some breeds – than in cats but tends to be more aggressive in cats. Spaying female dogs before their first heat dramatically reduces their risk of developing a malignant mammary tumor.
6.   Breastfeeding won’t cause your breasts to sag. Droopy breasts are a natural consequence of aging as skin loses elasticity and as dense breast tissue is replaced by fat, which is more prone to sagging. Smoking and multiple pregnancies are contributing factors but breastfeeding has no effect on elasticity and will not cause breasts to sag. Only corrective surgery can lift sagging breasts.
7.   The left breast is usually slightly larger than the right one. Very few women have perfectly symmetrical breasts. Differences in size up to 20% are normal. No one knows why the left breast is usually the larger one.
8.   Larger breasts don’t produce more milk. Milk production does not depend on the size of the breasts. Large breasts are often large because they contain more fat cells, not more milk-producing cells.
9.   Breasts are growing. The average bra size was 34B twenty years ago. Today, it is 34DD. Some of the change is due to companies inflating the sizes on their labels but increasing obesity, the number of women taking birth control pills, and exposure to environmental pollution are contributing factors.
10.   Breast implants won’t last a lifetime. Breast augmentation is the most commonly performed cosmetic surgery in the U.S. But women who get implants in their 20s should not expect to still have them thirty years later. “Most implants have a ten-year warranty”, says Dr. Chen, “but many develop problems well before then and have to be removed or replaced”.

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.