Any new nipple symptoms should be discussed with a doctor. Although nipple changes are often a benign breast condition, they can be a warning sign of a developing breast cancer. As such, timely investigation of any breast changes is important. Common nipple conditions include:
- Nipple skin changes
- Inverted nipples or retracted nipples
- Nipple discharge
How are nipple changes investigated?
At your appointment, Dr Lancashire will:
- Take a medical history
- Conduct a comprehensive physical examination of the breasts, nipples, and lymph nodes
- Order any other necessary investigations (e.g. ultrasound, mammogram, biopsy or other tests)
NIPPLE SKIN CHANGES
Nipple skin colour and texture can change naturally over a lifetime, often in relation to hormonal changes (e.g. menstrual cycle, puberty, pregnancy, breastfeeding, menopause), and are often no cause for concern. Despite this, certain nipple skin symptoms should be assessed by a doctor to exclude breast cancer.
You should see your doctor if you have noticed any of the following nipple symptoms:
Changes in nipple appearance
- Scaling, crusting, flaking, or peeling
- Thickening or hardening
- Lump(s) or bump(s)
- Dimpling or puckering
- Erosion, ulceration, blistering or sores
- Redness or rash
- Pigment changes
- Bleeding
- Discharge or weeping
- Inversion or retraction (‘turned-in’ or sunken position)
Changes in nipple sensation
- Pain or tenderness
- Burning
- Itching
- Stinging
- Aching
NIPPLE INVERSION OR RETRACTION
Nipples that turn inwards or rest flat against the breast (rather than pointing outwards) are referred to as ‘inverted’ or ‘retracted’. People may be born with inverted nipples or retracted nipples. An inverted or retracted nipple will usually respond to stimulation by turning outwards. In some cases, nipple inversion or retraction can be a sign of breast cancer.
What causes nipple inversion or retraction?
- Congenital maldevelopment (present from birth)
- Infection (e.g. acute mastitis)
- Sudden weight loss
- Fat necrosis (damaged fatty tissue in the breast)
- Duct ectasia (enlargement and inflammation of the ducts under the nipple)
- Surgical procedures to the breast
- Paget’s disease of the nipple
- Breast cancer
Is nipple inversion or retraction a concern?
You should see your doctor immediately if you have noticed nipple inversion or retraction that is:
- New
- Only in one breast
- Not moving outwards in response to stimulation
NIPPLE DISCHARGE
Discharge of fluid from the nipple is very common. Fortunately, most nipple discharge is benign (non-cancerous), meaning that it is rarely due to breast cancer. Nonetheless, all new nipple discharge should be investigated.
The breast ducts that come from the milk-producing breast lobules concentrate into the nipple, and anywhere from five to fifteen will open onto the surface. Nipple discharge can be of variable colour, consistency, and volume. Discharge may be from one nipple (unilateral) or both (bilateral). Discharge may happen from expression (in response to nipple stimulation, squeezing, or pressure to the breast) or spontaneously (no apparent reason or stimulus).
What causes nipple discharge?
- Hormonal changes
- Medications (including some illicit substances)
- Infection (e.g. acute mastitis)
- Breast cyst
- Breast abscess
- Duct ectasia (enlargement and inflammation of the ducts under the nipple)
- Papillomas
- Nipple skin conditions (e.g. eczema or dermatitis)
- Paget’s disease of the nipple
- Breast cancer
Is nipple discharge a concern?
Although nipple discharge is often normal (benign), you should see your doctor if you have noticed nipple discharge that is:
- New
- Only in one breast
- Happening spontaneously
- Blood stained
Can surgery treat nipple discharge?
Not all nipple discharge will require surgery. There are two main types of surgery that breast surgeons perform for nipple discharge. Both procedures require a general anaesthetic.
Microdochectomy
This is the removal of a single duct. It is often possible for a specialist breast surgeon to identify a single duct that the nipple discharge is coming from. Occasionally more than one duct maybe removed during this treatment.
Total duct excision
A total or ‘central’ duct excision is the removal of all the ducts under the nipple. If there are many ducts involved, or if a microdochectomy is not successful at controlling the discharge, Dr Lancashire may discuss a total duct excision with you.
The choice of operation can be complex, and Dr Lancashire will explain the rationale and potential side effects of the procedures in detail if they are recommended in your situation.
