Changes of the Nipple and Areola

Inverted or Retracted Nipples

Nipple variations, such as inverted nipples, retracted nipples, or other alterations can be congenital features that you were simply born with. However, you should always see your doctor if one or both of them differ from how they used to be. It is a change in your nipples that is of greatest concern.

Inverted nipples appear sunken or indented, rather than raised above the surface of the areola. Nipple inversion can occur as part of the normal aging process and is usually equal on both sides. But if you were born with nipples that were elevated and have become flattened, you should talk to your doctor, especially if the change only affects one side.

Retracted nipples, by contrast, have a slit-like area that is pulled inward. Retracted nipples may appear at birth, or develop gradually over time. A retracted nipple on one side only that develops quickly is not normal and may be an indication of a medical condition.

Breast cancer is the primary concern, especially if the retraction results in a change in a nipple's position or only affects one side. If stimulation doesn't affect the nipple or areola in any way, this is a sign of a problem as well.

Abnormal Discharge

Nipple discharge can be the sign of a problem. A discharge will typically come out of the same ducts that carry milk and may be milky, clear, yellow, green, brown, or bloody. The consistency can also vary from thick and viscous to thin and watery.

Nipple discharge can be caused by a normal menstrual cycle, benign tumors called fibroadenomas or lumps known intraductal papillomas (which are typically noncancerous).

An infection can cause a discharge with a pus-like appearance and a greenish-yellow tinge.

A milky discharge, similar to that seen in women who are breastfeeding, may occur in women who aren't breastfeeding, men, or even young children. This is referred to as galactorrhea, and may be due to medications, herbal supplements, low thyroid, or pituitary tumors.

Mammary duct ectasia is another cause of nipple discharge and is most common around the time of menopause. The discharge is usually thick and sticky, grey appearing, and may have a green tint. This is a benign condition that occurs as milk ducts become swollen and clogged around the time of menopause.

Nipple Lumps and Bumps

Your nipple and areola can suddenly get become erect and may feel bumpy when touched or exposed to cold. This is a perfectly normal response that typically resolves once the stimulation is removed.

During pregnancy, the bumps on the areola (called Montgomery glands) engorge in preparation for breastfeeding. However, if you develop bumps or lumps on or just beneath your nipple or areola when you aren't pregnant, you should have them checked out.

This may be the sign of something as simple as a clogged milk duct, an intraductal papilloma, a blister, or a treatable infection such as an abscess. But it may also be the sign of ductal carcinoma in situ (DCIS), a treatable form of early-stage breast cancer.

To determine the cause, your doctor may opt to perform either a fine needle biopsy or an imaging test called ductography to evaluate the true nature of the lump.

Changes in Size

It is normal for your breasts and nipples to swell in response to your menstrual cycle or when you are pregnant or breastfeeding. The same can happen when using oral contraceptives.

However, if one breast grows noticeably larger, it is something you'll definitely want looked at. It may also be associated with mastitis, an infection of the breast tissue. Breast cancer can cause asymmetrical changes in breast size, either suddenly or gradually.

If, on the other hand, your breasts have always been asymmetric, don't worry—few women are perfectly balanced. It is only a change in size that is concerning.

Changes in Skin Texture and Color

During pregnancy, your nipples and areola may become darker in color; your areola itself may also become visibly larger. When these changes are either unilateral (occurring on one side), unevenly distributed on both sides, or occur outside of pregnancy, they are generally not considered normal.

Changes include thickening of the skin, visible swelling or inflammation, an "orange peel" texture, a change of nipple direction, or noticeably warmer skin temperature.

Causes may include:

• Eczema: An itchy skin rash
• Inflammatory breast cancer: This is a rare cancer that causes the swelling of the breasts. At first, this may appear to be eczema, but can rapidly spread and cause skin to become red and tender.
• Squamous cell carcinoma: A common skin cancer associated with overexposure to the sun.
• Paget's disease of the nipple: A rare type of breast cancer that starts on the nipple and extends to the areola, and may cause breast lumps or tumors over time.
• Bowen's disease: A very early form of skin cancer that is easily treatable.

Nipple Pain

Outside of pregnancy or your menstrual cycle, there is no such thing as normal nipple pain. If you have persistent nipple tenderness, itchiness, or pain that was not caused by an injury, you need to get it looked at.

Nipple pain is an uncommon symptom of breast cancer, but it can be the first symptom of a developing malignancy. It may also be a sign of mastitis, fibroadenoma, or a benign cyst.