NIPPLE CHANGES

Nipple Inversion and Retraction

Inverted nipples are those that turn inward rather than protruding outward. While inverted nipples are sometimes called retracted nipples, there is a difference between the two. Retracted nipples, instead of sinking or turning inward, rest flat against the rest of the breast when not stimulated.

There are many causes of nipple inversion.

Normal Variation

Inverted nipples can be a normal variation of nipple type. Some people are born with inverted nipples. Nipple inversion can also occur slowly and gradually with age. Inverted nipples that are not caused by a medical condition do not require treatment. Surgery can be performed to correct an inverted nipple for aesthetic reasons.

Duct Ectasia

Duct ectasia is a benign condition in which there is enlargement and inflammation of the ducts under the nipple. It usually occurs in women after menopause. Duct ectasia can also cause nipple discharge. In most cases, no treatment is required. If the discharge is a nuisance, the ducts behind the nipple can be removed surgically.

Paget's Disease of the Nipple

Paget's disease of the nipple is an uncommon type of breast cancer in which cancer cells grow in the nipple-areolar complex. Paget’s disease causes the nipple skin to become red, painful, scaly and sometimes ulcerated, and it may be associated with blood-stained or clear nipple discharge.

Breast Cancer

Nipple inversion that occurs suddenly always require investigation with the triple test, as it could be a sign of breast cancer forming underneath and pulling the nipple inwards. Around 8% of women with breast cancer present with nipple changes.

Skin Changes of the Nipple

There are many causes of skin changes of the nipple.

Nipple Eczema

Eczema or dermatitis affecting the skin of the nipple, particularly if it becomes infected, can cause a weeping discharge associated with crusting of the nipple. Punch biopsies of the affected skin may be required to rule out Paget's disease. Treatment is with steroid based creams, the same as for eczema elsewhere in the body.