Change in the appearance of a nipple or the area around it (areola)
There are two main types of nipple abnormality: retraction into the breast (nipple inversion) and disorders affecting the skin on or around the nipple. Although these abnormalities are most often caused by minor problems that are easily treatable, any changes in the condition of the nipples should receive medical attention because, in rare cases, they may indicate breast cancer.
Inversion of the nipples may occur during puberty if the breasts do not develop properly. This type of inversion is usually harmless, although it may later make breast-feeding difficult. Nipple inversion may also occur as a result of inflammation of the milk ducts behind the nipple. This condition most often affects nonpregnant women who smoke. Changes in the structure of the breasts as they age may cause the nipple to be drawn into the breast in older women. Less commonly, nipple inversion that develops in adulthood may be due to breast cancer.
Many women develop fine cracks and tender areas on their nipples during the first few weeks of breast-feeding (see Cracked nipples). These cracks are most often the result of the baby not taking the whole nipple into his or her mouth properly when feeding. Leaving the nipples wet after a feed can also cause them to become sore and cracked. Cracked nipples often cause stabbing or burning pain as the baby starts or stops feeding and may become infected, causing inflammation of the breast tissue (see Mastitis).
Dry, flaky patches of skin that occur on or around both nipples may be due to eczema. Eczema is usually itchy and tends to occur in several sites on the body. However, occasionally, skin changes on the nipples that resemble eczema are in fact caused by Paget’s disease of the breast, a rare form of cancer that originates in the milk ducts. Unlike eczema, Paget’s disease rarely develops on both nipples and does not heal. This type of breast cancer often causes soreness and bleeding from the nipple. It may also cause a breast lump, although if diagnosed early enough, a breast lump is unlikely to have developed when the diagnosis is made.
Your doctor will examine your breasts, paying particular attention to your nipples. If nipple inversion has occurred in adulthood but is not related to breast-feeding, your doctor may refer you to a breast clinic, where you may have ultrasound scanning or mammography to look for breast abnormalities. If a breast lump is found, cells or fluid may be taken from it using a needle and syringe (see Fine-needle aspiration of a breast lump) and examined for cancerous cells. A skin sample may also be taken and tested for cancerous cells.
Occasionally, it is possible to correct nipple inversion that has been present since puberty by gently drawing the nipples out between your thumb and forefinger every day for several weeks. Suction devices, such as nipple shells, which are temporarily worn in your bra, can also help to draw out the nipple.
If your nipples have become cracked, washing and drying them carefully and applying a moisturizer may help. Make sure that you wash the moisturizer off before breast-feeding. You should also avoid plastic-lined breast pads, which may become damp and encourage infection. Infection is usually treated with antibiotics, and eczema can be improved by hydrocortisone cream (see Topical corticosteroids).
If cancer of the breast is discovered, you will be referred for additional tests and treatment (see Breast cancer).
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.