In this article we’re going to look at nipple problems in men and in women who aren’t pregnant or breastfeeding. What causes them and what tests are done. We will also look at the range of ‘normal’ for different women.
What does a normal nipple look like?
The nipple is made up of the areola – the coloured area around the teat of the nipple – and the teat, or nipple itself.
You can see from the anatomy picture that the ducts from the milk glands drain into the
The size of the teat part of the nipple varies, so that some are larger and more protruding than others. This part of the breast is particularly full of nerve endings.
The coloured part – the areola – varies in size and colour, being darker in dark-skinned women. In some women the areola is small and in some it is larger, covering more of the breast.
What’s important is that, if you notice changes you discuss them with your doctor.
About 10-20% of women are born with inverted nipples on one or both breasts. This is rarely a problem for a woman who wants to breast feed as the nipples usually become protracted (forward-pointing) with the influence of pregnancy hormones.
Otherwise it’s usually a cosmetic issue and an experience cosmetic surgeon may recommend a correcting operation. However surgery can prevent a woman from breastfeeding in the future.
What causes inverted nipples?
- Sudden weight loss
- Trauma to the breast
- Infection to the breast – both of these can cause scaring in the ducts, which makes them shorten and pull the nipple inwards.
- Gynaecomastia (in men)
- Breast tumours
- Some genetic disorders
- Breast sagging or drooping.
- If you’re worried by having inverted nipples and want to look for a plastic surgeon who will help, read this article on how to find a good cosmetic surgeon.
This can be caused by:
- Infection – bacterial or fungal
- Trauma to the nipple, eg where it’s rubbed on clothing etc
- Dry or cracked skin on the areola
- Paget’s disease of the breast (flakey skin on the nipple, discharge, burning pain in the nipple/breast).
Treatment will depend on the cause.
Milky nipple discharge.
Different problems cause discharge from one or both breasts. It is more likely to occur in older women and/or in those who have had children. Other causes include:
- A hormone-producing tumour in a gland in the brain called the pituitary. The tumour is called a prolactinoma, and it produces prolactin, the hormone that makes the milk come into the breast after childbirth. The tumour is not cancerous. (Usually affects both breasts.)
- Non-cancerous growth in the breast called an intraductal papilloma. (Usually affects 1 breast.)
- Injury to the breast tissue. (Usually affects 1 breast.)
- Breast abscess, most common during breast-feeding. (Usually affects 1 breast.)
- Having an underactive thyroid. (Usually affects both breasts.)
- A side effect of some meds – some birth control pills, anti nausea drugs, heart meds and anti-depressants can cause nipple discharge. (Usually affects both breasts.)
- Breast cancer – rare. (Usually affects 1 breast.)
Nipple discharge can also be:
- A clear fluid
Skin changes to the nipple may include:
- Changes to the colour of the areola
- Changes in the texture of the areola
- Puckering of the skin of the areola or breast
- Rashes over the breast/nipple.
These changes should be discussed with your doctor.
What tests will the doctor do for nipple discharge?
The doctor will discuss your physical health and whether it’s likely that you are pregnant, as well as your history of pregnancies.
Some of the discharge may be taken as a sample and sent to the lab to look for signs of infection.
You will also have blood tests looking for hormone levels – thyroid hormone, prolactin (see above).
You may also have a mammogram and/or scans of the breast.
These tests will tell the doctor about the cause of the problem and treatment will go from there.
If you’re worried about your symptoms or medical problem but don’t want to seek professional help because you feel embarrassed, silly or that it’s your fault in some way, read this page now: How to talk to a doctor about an embarrassing problem.