Patricia,
 You wrote

<some inverted nipples are inverted due to adhesions preventing the
muscles from erecting the nipple>

I too have a great interest in the anatomy of inverted and retracting
nipples.

The word "adhesions" brings to my mind a process such as trauma, surgery
or inflammation happening to otherwise normal tissues that has resulted
in the raw places forming a sort of connective scar tissue.

However, I have seen the word "adhesions" used frequently enough in the
context of nipple descriptions that I wonder if you or other lactnetters
are aware of any background references from either cancer or plastic
surgery, histology, dermatology, anatomy or other such sources that are
actually looking under a microscope rather than repeating an imprecise
term they may have seen others use?

The embryology literature I have been able to read describes as a normal
stage of embryological/fetal development, the growth of solid bands
developing inward from the skin surface. There are other developmental
processes that are supposed to follow that stage.

From my observations it seems to me that rather than trauma, irritation
or surgery, arrested development of the remainder of that sequence is a
main part of the reason that some nipples fail to evert completely.

The term "inverted" is used so loosely that I never know what to expect
to see when a mother comes to me for evaluation, reporting someone told
her she had inverted nipples. For many, their self-esteem seems to take a
discouraging plunge when the term is applied to them.

I have seen a variety of inverted nipples, each remarkably different from
others, and many, many more nipples that simply retract when compression
taxes the elasticity of the underlying tissue. This is often affected by
the overhydration of the area, and is transient (eventually).

I view this semantical problem as an unrecognized, "uncontrolled
variable" in the few research projects that continue to be quoted. While
their conclusions may have benefitted some mothers, they serve many other
mothers poorly.

I am hungry for scientific references anyone can provide me, in order to
continue delving into the quandaries this often presents.

Jean
****************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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