Cancer Breast Cancer Symptoms Changes of the Nipple and Areola What's Normal—and What's Not By Serenity Mirabito RN, OCN Serenity Mirabito RN, OCN Serenity Mirabito, MSN, RN, OCN, is a published oncology nurse writer who advocates for those surviving and thriving with cancer. Learn about our editorial process Updated on January 25, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Anita Sadaty, MD Medically reviewed by Anita Sadaty, MD Facebook LinkedIn Twitter Anita Sadaty, MD, is a board-certified obstetrician-gynecologist at North Shore University Hospital and founder of Redefining Health Medical. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Size and Color Color Texture Bumps Areola Hair Discharge Nipple Pain Inverted Nipples Extra Nipple Frequently Asked Questions 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. Breast Anatomy Is Complex and Intricate Verywell / Emily Roberts 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. When to Call Your Healthcare Provider Changes to the nipple and the areola of one breast are more concerning than changes in both. Still, you should report any unusual changes 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 gainIrregular periodsAcne 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: MilkyClearYellowGreenBrownBloody 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 spontaneousIt is bloody or clearThe fluid is discharged from one nippleYou have other symptoms like a lump, nipple pain, or changes in skin texture What Type of Nipple Discharge Do You Have? 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. A 2018 study estimated that 80%–90% of people who breastfeed experience sore nipples at some point. 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: BreastfeedingExposure to the coldNipple trauma In rare cases, nipple pain is a symptom of breast cancer, particularly Paget's disease of the nipple. See your healthcare provider if you have:Persistent nipple tendernessItchinessPain without an obvious cause 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. Causes of Nipple Pain 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. Variations in Nipple Shapes and Sizes and When to Be Concerned 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. Frequently Asked Questions What are the five stages of breast development? The five stages of breast development according to the Tanner Stages are:Stage 1: No glandular breast tissue palpable Stage 2: Breast bud palpable under the areola (first pubertal sign in females)Stage 3: Breast tissue palpable outside areola; no areolar developmentStage 4: Areola elevated above the contour of the breast, forming a “double scoop” appearanceStage 5: Areolar mound recedes into single breast contour with areolar hyperpigmentation, papillae development, and nipple protrusion What hormone causes nipple changes? Hormones called estrogens are responsible for nipple, areola, and breast changes. When should your nipples be fully developed? In general, breasts begin to develop between the ages of 8 and 13. Typically, female breasts are fully developed between 17 and 18 years old. However, they can continue to grow into the early 20s. Originally written by Pam Stephan Pam Stephan Pam Stephan is a breast cancer survivor. Learn about our editorial process Was this page helpful? Thanks for your feedback! Get honest information, the latest research, and support for you or a loved one with breast cancer right to your inbox. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 18 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Zucca-Matthes G, Urban C, Vallejo A. Anatomy of the nipple and breast ducts. Gland Surg. 2016 Feb; 5(1): 32–36. doi:10.3978/j.issn.2227-684X.2015.05.10 De Sanctis V, Elhakim IZ, Soliman AT, Elsedfy H, Soliman N, Elalaily R. 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Miranda EP. Congenital defects of the skin and hands. Polythelia and polymastia. In: Pediatric Surgery (Seventh Edition). Elsevier; 2012. National Institutes of Health, Genetic and Rare Diseases Information Center. Supernumerary nipple. Emmanuel M, Bokor BR. Tanner stages. StatPearls Publishing. Additional Reading Shaheed SU, Tait C, Kyriacou K, Linforth R, Salhab M, Sutton C. Evaluation of nipple aspirate fluid as a diagnostic tool for early detection of breast cancer. Clin Proteomics. 2018 Jan 11;15:3. doi:10.1186/s12014-017-9179-4. Yılmaz R, Bender Ö, Çelik Yabul F, Dursun M, Tunacı M, Acunas G. Diagnosis of nipple discharge: Value of magnetic resonance imaging and ultrasonography in comparison with ductoscopy. Balkan Med J. 2017 Apr 5;34(2):119-126. doi:10.4274/balkanmedj.2016.0184.