Nipple Disorders in Women
Most problems with nipples are related to pregnancy and breastfeeding. But there are a few symptoms and diseases that can affect nipples at other times in your life.
Nipples contain small milk ducts that become active after pregnancy and during breastfeeding, when they start producing milk. The area of darker skin surrounding the nipple is called the areola. It is normal for the nipple and areola to become bigger and darker during pregnancy and breast-feeding. Problems with the nipple itself are commonly related to breastfeeding.
There are so many changes that occur in the nipple with pregnancy, many of which are normal! For example, the areola may often become darker because of pregnancy-related hormones, and glands on the nipple can become more prominent to allow for increased lubrication of the nipple. The nipples may also spontaneously produce colostrum even prior to delivery. (If that doesn’t happen, it does not mean that you will not produce breast milk!) —Dr. Huma Farid
A small percentage (3%) of girls are born with nipples that turn inward, but it’s not a long-term issue. If you want the retraction reversed for cosmetic reasons, it can usually be done with a simple surgical procedure.
But if your nipple suddenly becomes inverted, it can be a sign of breast cancer and you should see a doctor immediately.
Paget disease of the nipple
Paget disease of the nipple is an uncommon type of breast cancer. It is a slow-growing cancer that starts in the milk ducts. The first symptom is often an itchy sore on your nipple.
If you have a sore on your nipple that itches or burns, see your doctor immediately. Your doctor may take a sample of cells to check for cancer. If the cancer is caught early, the chance of a cure is excellent. Depending on how far advanced the cancer is, treatment may include surgery.
Some nipple changes may be normal, but it is important to clarify the changes that occur with your doctor as the treatment is different. For example, nipple discharge could be a result of breastfeeding, an infection, medications, or benign growth. —Dr. Farid
The most common type of nipple discharge is the milky fluid that can leak in pregnant or breastfeeding women. But there are other types of discharge.
- Women who are not pregnant or breast-feeding may also have a small amount of watery or milky discharge when they squeeze their breasts or nipples.
- Milk production is stimulated by a hormone called prolactin, produced by the pituitary gland in the brain. Tiny noncancerous tumors of the pituitary gland called prolactinomas can cause a milky discharge by increasing prolactin levels in the blood. The discharge typically comes from both breasts. You may also have other symptoms with high prolactin levels, such as an irregular menstrual cycle, which can lead to infertility. This can be reversed by medications that normalize prolactin levels.
- Milk production may also occur when taking birth control pills or medicines that lower blood pressure or stabilize mood.
- Fluid from the nipple that is thicker, yellow or green, or has an odd smell, may be pus from an infection such as mastitis. Mastitis is an inflammation of the breast tissue, usually due to a blocked milk duct, which causes bacteria to multiply. The bacteria normally live on the skin or in the mouth of a nursing infant and are transferred to the breast during nursing. Mastitis causes breast pain as well.
If you are not pregnant or breast-feeding and notice a nipple discharge, see your doctor. Bring a list of all medicines you take. Your doctor will also want to know whether you have irregular periods.
They will perform a breast exam, try to express a sample of the discharge, and may check your prolactin level with a blood test. If it is higher than normal, your doctor may order X-rays of your brain to look for a prolactinoma.
Cysts in the areola
Cysts in the areola (the dark area around your nipple) are small, movable sacs filled with fluid or pus. These cysts are most often a noncancerous (benign) breast condition. They can be caused by a blocked oil gland in the nipple or a bacterial infection.
See your doctor if you have a cyst. Depending on how the cyst looks, they may recommend applying heat to help the cyst rupture on its own or may drain it by lancing it. Antibiotics can help treat any infection.
A common misconception is that any nipple abnormality equals malignancy, which is not true. There are many non-cancerous reasons for changes in the nipples. Hormones can also cause changes in the nipple. —Dr. Farid
An intraductal papilloma is a small, firm growth of tissue in the milk duct of the breast. It is a noncancerous tumor. It often causes discharge from the nipple.
If you detect a lump in your breast or have a discharge, see your doctor immediately. They may use a needle to remove fluid from the growth or may remove the growth itself. They will have the fluid or tissue evaluated for the presence of cancer cells. No treatment is necessary for an intraductal papilloma.
Dr. Huma Farid is an obstetrician/gynecologist at Beth Israel Deaconess Medical Center and an instructor in obstetrics and gynecology at Harvard Medical School. She directs the resident colposcopy clinic and is the rotation director for labor and delivery at BIDMC. Dr. Farid graduated from Harvard Medical School. When not involved in resident education or patient care, she enjoys reading and writing.