Changes of the Nipple and Areola

Many factors can alter the appearance, shape, or texture of your nipple and areola. Sometimes these changes are temporary and due to hormonal shifts, pregnancy, or breastfeeding. Permanent changes of the nipple or areola are often seen with breast surgeries, weight loss, and aging. It's important to be familiar with what is normal for your breasts and report any changes to your medical provider.

This article will discuss the normal and abnormal variations of the nipple and areola.

Size

Nipples and areolas vary in size. The areola is a pigmented circular area around the nipple, usually between 3 centimeters and 6 centimeters (1.2 inches to 2.4 inches) across. The size of nipples and areolas can sometimes correlate to breast size, but genes can also play a role. It's normal for nipples and areolas to change in size during puberty, certain stages of your menstrual cycle, pregnancy, and breastfeeding.

Inform your healthcare provider of any changes in the texture (such as an orange peel feeling), skin condition (ulcerations), or pain of the nipples or areolas.

Color

The areola is often darker than the nipple itself. Depending on your skin tone, it can range from pale pink to dark brown. Hormonal changes (menstrual cycle and menopause), breast surgery, pregnancy, and breastfeeding can result in a color change of the nipple and areola. The color will return closer to normal as hormones normalize and after pregnancy.

A change in nipple color to red, purple, or dark purple, especially accompanied by itching or drainage, should be reported immediately to your healthcare provider.

Texture

The skin texture of the nipple is normally smooth, whereas the areola can be bumpy and pimple-like. Montgomery glands, which are responsible for lubricating the nipple and areola during lactation, are the raised areas on the areola. Eczema, a treatable skin rash, can change the texture of the areola.

Skin thickening, redness, swelling, and warmth could be indications of serious conditions like inflammatory breast cancer or Paget's disease of the nipple. Notify your healthcare provider if you have these symptoms.

Bumps

Your nipples normally become erect when touched or exposed to the cold. The areolas may become more firm as well. During pregnancy, the Montgomery glands enlarge in preparation for breastfeeding. As a result, the glands can become clogged, resulting in an infection. Clogged Montgomery glands can be treated with antibiotics and home remedies.

You should see a healthcare provider if you're not pregnant and develop any new lumps or bumps.

Areola Hair

It's normal to have a few hairs on your areolas. However, plucking or tweezing your areola can cause ingrown hairs and infected follicles. Cutting or shaving are better options.

It's not typical to have more than a few hair strands on each areola. More hair than that can be a sign of polycystic ovary syndrome (PCOS).

PCOS is a hormonal imbalance (when there are more androgens, male hormones, than typical) that can cause infertility. Symptoms include:

• Weight gain
• Irregular periods
• Acne

Talk to your healthcare provider if you notice an increase in hair growth on your breasts.

Nipple Discharge

Although nipple discharge is uncommon, it's not always abnormal. It can be caused by hormonal changes or pregnancy.

Nipple discharge is typically released from the milk ducts and may be:

• Milky
• Clear
• Yellow
• Green
• Brown
• Bloody

The consistency can vary from thick and viscous to thin and watery. If benign (not harmful), the discharge usually comes from both breasts. The fluid may leak spontaneously or only when the breasts are squeezed or stimulated.

During pregnancy, a milky discharge is normal as the breasts are preparing to produce milk. Sometimes, certain stages of the menstrual cycle can cause discharge.

Other causes of nipple discharge include:

• Mammary duct ectasia: Clogged or swollen milk ducts
• Galactorrhea: Discharge that is similar to breastmilk but occurs when not lactating
  
• Intraductal papilloma: Benign tumors called fibroadenomas

Nipple discharge is more likely to be related to breast cancer when:

• It is spontaneous
• It is bloody or clear
• The fluid is discharged from one nipple
• You have other symptoms like a lump, nipple pain, or changes in skin texture

Nipple Pain 

Some nipple pain is normal or expected. For example, it's common for your breasts and nipples to be sore just before menstruation. In addition, breastfeeding can cause raw, cracked, and bleeding nipples.

Several benign and treatable conditions associated with nipple pain include:

• Mastitis (a breast infection)
• Yeast infection of the nipple
• Eczema

Raynaud's phenomenon can cause nipple vasoconstriction, resulting in episodes of pain, burning, and/or tingling. This can occur with:

• Breastfeeding
• Exposure to the cold
• Nipple trauma

In rare cases, nipple pain is a symptom of breast cancer, particularly Paget's disease of the nipple.

Sensitive Nipples

Some people's nipples are more sensitive than others. As a result, they may be irritated by certain laundry detergents or fabrics. For example, long-distance runners can experience more nipple pain than nonathletes due to chafing. Reduce chafing by wearing a correctly fitted, breathable cotton bra. Using a detergent for sensitive skin can also help prevent nipple irritation and sensitivity.

Sexual arousal is another reason for sensitive nipples. This occurs because the brain registers nipple stimulation as a sexual act.

Inverted Nipples

Nipple variations are usually something people are born with. They include inverted nipples, also called retracted nipples. Inverted nipples look sunken or indented. They can also occur as part of the normal aging process, typically on both sides.

If your nipples used to stick out and have suddenly become flattened, especially on just one side, talk to your healthcare provider. In some cases, this can be a sign of breast cancer.

Breastfeeding Challenges

Inverted nipples can make it difficult to breastfeed. A baby's mouth typically firmly latches on to the protruding nipple and part of the areola, which stimulates milk production. Certain techniques and devices, like nipple shields, can improve breastfeeding success. You may also want to see a lactation consultant for further support.

Extra Nipple 

Having extra nipples is called supernumerary nipples or polythelia. An estimated 0.2%–2.5% of the population has polythelia. This condition is considered a minor congenital defect.

Extra nipples are usually small and below the breasts. Therefore, they may not be noticeable until puberty or pregnancy. Extra nipples are benign and do not need to be treated or removed.

Summary

Nipples and areolas vary in size, shape, color, and texture. Becoming familiar with how your nipples and areolas look is important. Sudden changes in their appearance should be reported to your healthcare provider immediately.

Other issues like excessive hair growth, leaking nipples, sudden retraction, or inversion of the nipples also need to be evaluated. Although these changes may be normal depending on hormonal changes, pregnancy, or aging, they could also be signs of serious conditions or illnesses.

A Word From Verywell

Many women are self-conscious about the appearance of their nipples and areolas. Although undergoing breast surgery to correct the perceived problem is a solution, so is practicing body positivity. Genetics and race play a large part in how nipples and areolas appear. Learning to love and honor these differences is important for self-esteem and confidence.

From puberty to menopause it's normal for your nipples and areolas to change. It's essential, however, to report sudden or one-sided changes to your healthcare provider immediately.