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The Ins and Outs of Nipple Changes

Know Nipple and Areola Signs of Health and Disease

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Updated April 04, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Nipple changes can occur in response to a lover's caress, a baby's cry, during breastfeeding, or sometimes from a medical condition. Not all nipple changes are breast cancer, but knowing which are expected changes and which are signs of disease is critical to your breast health.

Nipple and Areola Anatomy

Your nipple is the focal point of each breast -- a small, sensitive, raised area in the center of the areola. Each nipple contains ducts through which breast milk flows during breastfeeding.

Nipples and areolas can vary in size, shape and coloration, so resist comparing them to any others.

During pregnancy and breastfeeding, your nipples and areolas can change to prepare for nursing. Nipples should be examined as part of your monthly breast self-exam.

The Ins and Outs of Nipple Changes

Nipple Retraction
Art © A.D.A.M.

 

Inversion or Retraction: 

  • Inverted nipples appear to be indented in your areola, instead of raised above the surface of your breast.  Nipple inversion is congenital and does not mean you have breast cancer. Inverted nipples can be coaxed "out of hiding" with some stimulation; plastic surgery can also be performed to correct this.
  • Retracted nipples start out as raised tissue, but due to some underlying condition, the nipple starts to pull inward.  If your nipple is not normally inverted or flat, but changes so that it retracts and will not return to its regular position when stimulated, it might be a sign of a problem.  Breast cancer can signal its presence with a retracted nipple, so see your doctor if you have this kind of nipple change.

Nipple Discharge

Nipple Discharge
Art © A.D.A.M.

Most nipple discharge is benign, caused by infections, fibroadenomas, intraductal papillomas, pregnancy, clogged milk ducts or breastfeeding.  If you see bloody discharge, leakage from only one nipple, or discharge that is unrelated to pregnancy or breastfeeding, get it checked out.

Lumps and Bumps

Nipples and areolas may become a bit bumpy when you get cold, but this should subside when your skin warms up.  When doing your monthly breast self-exam, you may discover persistent bumps or lumps on or just beneath your nipple or areola.  If you do, see your doctor to confirm what's causing these lumps.  It could be plugged milk ducts, an intraductal papilloma, or an infection.

Tiny bumps on your areola could be Montgomery glands. You may need to have a ductogram or a fine needle biopsy done to determine the true nature of a nipple lump.  Sometimes a lump beneath your nipple or areola is ductal carcinoma in situ, a highly treatable form of early-stage breast cancer.

Nipple and Areola Skin Changes

Breast Skin Change
Art © Pam Stephan

During pregnancy, your breasts will change in response to hormones.  As your breasts prepare for breastfeeding, your nipple and areola should become darker in color, and your areola may become larger.  Regardless of whether you are pregnant or not, watch out for these skin changes:  thickened skin, orange peel texture, inflamed appearance, warmer than normal skin temperature, or change of nipple direction.  You may have an ordinary rash or breast infection, but get it checked by a doctor to make sure it is not Paget's disease of the nipple or inflammatory breast cancer.

Size Changes

Your breasts may swell in response to your menstrual cycle, or when you are pregnant or breastfeeding.  Don't be surprised if your nipple and areola also grow somewhat during pregnancy. This is a normal change.  However, if one breast grows larger than the other, or exhibits skin changes, be sure to have a clinical breast exam to determine the cause. 

Breast cancer can cause a gradual or sudden asymmetrical change in breast size.  If you breasts are normally asymmetrical, not to worry -- few of us are perfectly balanced.  It is a change in size that can cause concern.

Nipple Pain

If you have persistent nipple tenderness, itchiness, or pain that’s not related to your menstrual cycle, it could be related to breastfeeding problems, infections, or intraductal papillomas.  You could try home treatment for nipple pain, but if the discomfort does not subside, visit your doctor.

Bottom Line on Nipple and Areola Changes

Be well acquainted with your breasts. Look at them. Touch them. Do your monthly breast self-exam so you will know that is normal for you. Keep an eye out for nipple changes, lumps, or unusual pain. Get help if you find a change in your breasts, and remember that 80% of all breast lumps are benign -- but early detection still saves lives.

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Sources:

Nipple-Areolar Complex: Normal Anatomy and Benign and Malignant Processes. Brandi T. Nicholson, MD, Jennifer A. Harvey, MD and Michael A. Cohen, MD. March 2009  RadioGraphics,   29,  509-523.

Understanding Breast Changes: A Health Guide for Women. National Cancer Institute. Posted: 09/28/2009

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