The Ins and Outs of Areola and Nipple Changes

Nipple and Areola Signs of Health and Disease

Nipple and areola changes can occur in response to a lover's caress, a baby's cry, during breastfeeding, or sometimes from a medical condition. Not all nipple changes are breast cancer, but knowing which are expected changes and which are signs of disease is critical to your breast health. Here is a review of some of the common abnormal conditions which may affect the nipple in both women and men.

Nipple and Areola Anatomy

An illustration of the female body showing the nipples and areola
An illustration of the female body showing the nipples and areola of the breast. SEBASTIAN KAULITZKI/SCIENCE PHOTO LIBRARY/Getty Images

Your nipple is the focal point of each breast—a small, sensitive, raised area in the center of the areola. Each nipple contains ducts through which breast milk flows during breastfeeding.

Nipples and areolas can vary in size, shape, and coloration. Just as other parts of our bodies differ in a number of ways, the appearance of a woman's nipples and areolas can vary widely.

During pregnancy and breastfeeding, your nipples and areolas can change to prepare for nursing. Nipples should be examined as part of your monthly breast self-exam and as part of a clinical exam with your physician.

Inversion or Retraction

Inverted nipples appear to be indented in your areola, instead of raised above the surface of your breast. Nipple inversion is usually congenital and does not mean you have breast cancer. Inverted nipples can be coaxed "out of hiding" with some stimulation; plastic surgery can also be performed to correct this.

Retracted nipples start out as raised tissue, but due to some underlying condition (such as inflammation or scarring), the nipple starts to pull inward. If your nipple is not normally inverted or flat but changes so that it retracts and will not return to its regular position when stimulated, it might be a sign of a problem. Breast cancer can signal its presence with a retracted nipple, so see your doctor if you have this kind of nipple change.

Nipple Discharge

Most nipple discharge is benign, caused by infections, fibroadenomas, intraductal papillomas, pregnancy, clogged milk ducts, or breastfeeding. 

Intraductal papillomas are most commonly benign but may contain atypical hyperplasia which is associated with an increased risk of developing breast cancer.

Nipple discharge can also be a sign of breast cancer. The type of discharge related to cancer is often slightly bloody and occurs in only one breast. That said, even a milky discharge has sometimes been found as a sign of breast cancer. If you have any discharge from your breasts that is unrelated to pregnancy or nursing, talk to your doctor.

Lumps and Bumps

Nipples and areolas may become a bit bumpy when you get cold, but this should subside when your skin warms up. When doing your monthly breast self-exam, you may discover persistent bumps or lumps on or just beneath your nipple or areola. If you do, see your doctor in order to find out what's causing these lumps. It could be plugged milk ducts, an intraductal papilloma, or an infection.

Tiny bumps on your areola could be Montgomery glands. You may need to have a ductogram or a fine needle biopsy done to determine the true nature of a nipple lump. Sometimes a lump beneath your nipple or areola is ductal carcinoma in situ, a highly treatable form of early-stage breast cancer.

Nipple and Areola Skin Changes

During pregnancy, your breasts will change in response to hormones. As your breasts prepare for breastfeeding, your nipple and areola should become darker in color, and your areola may become larger.

Regardless of whether you are pregnant or not, watch out for these skin changes: thickened skin, orange peel texture, inflamed appearance, warmer than normal skin temperature, or change of nipple direction.

Some abnormal conditions which may begin in the skin of the nipple include:

Certainly, irritation and eczema are the most common causes of skin changes on your nipple, yet other conditions can also look very similar, at least early on.

Nipple and Areola Size Changes

Your breasts may swell in response to your menstrual cycle, or when you are pregnant or breastfeeding. Don't be surprised if your nipple and areola also grow somewhat during pregnancy. This is a normal change. However, if one breast grows larger than the other, or exhibits skin changes, be sure to have a clinical breast exam to determine the cause.

Breast cancer can cause a gradual or sudden asymmetrical change in breast size, with one breast becoming larger or smaller than the other. If your breasts are normally asymmetrical, don't worry—few of us are perfectly balanced. It is a change in size that can cause concern. The easiest way to determine if your breasts are just going through their monthly cycle in size or whether there is a true change in size is the take a look at how your bras fit. Do they seem to be tight or uncomfortable in an area in which they were previously comfortable?

Nipple Pain

If you have persistent nipple tenderness, itchiness, or pain that’s not related to your menstrual cycle, it could be related to breastfeeding problems, infections, or intraductal papillomas. You could try home treatment for nipple pain if you are nursing but if the discomfort does not subside, visit your doctor.

While nipple pain is an uncommon symptom of breast cancer, it has, at times, been the first symptom of the disease.

Bottom Line on Nipple and Areola Changes and Health

Be well acquainted with your breasts. Look at them. Touch them. Do your monthly breast self-exam so you will know that is normal for you. Keep an eye out for nipple changes, lumps, or unusual pain. Get help if you find a change in your breasts, and remember that 80 percent of all breast lumps are benign—but early detection still saves lives.

Be your own advocate in your health care. If something doesn't seem right to you, keep asking questions. If you're not getting answers, get a second opinion. Nobody is as motivated as you are to keep your body healthy and free from disease.

Sources:

Adams, S., and R. Kanthan. Paget’s Disease of the Male Breast in the 21st Century: A Systematic Review. Breast. 2016. 29:14-23.

Parthasarathy, V., and U. Rathnam. Nipple Discharge: An Early Warning Sign of Breast Cancer. International Journal of Preventive Medicine. 2012. 3(11):810-4.

Pasquali, P., Freites-Martinez, A., Camacho, E., and A. Fortuno. A Painful Nipple: A Rare Presentation for an Infiltrating Lobular Carcinoma. Breast Journal. 2016. 22(1):117-8.

Nipple and Areola Reconstruction

 Many people become acutely aware of their nipples and areolas after they are gone, as part of breast cancer surgery. Some of the functions of your nipples, such as giving your body symmetry and in essence, a dividing point between your upper chest and your lower abdomen, are noted only after they are no longer present. Thankfully, for those who are concerned, nipple and areola reconstruction after breast cancer surgery offers many options.

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