Nipple and areola changes can occur in response to any number of things. Sometimes it’s reactive, such as when it is touched or the temperature is cold. At other times, the changes are related to hormones, whether during pregnancy or in response to a woman’s menstrual cycle. Even age can be a factor for perfectly normal changes to the nipples.
But when the changes are sudden and unexplained or worsen progressively, it may be the sign of a medical problem. Knowing how to spot the signs can help you determine whether the changes are normal or if it’s time to see a doctor.
Inverted or Retracted Nipples
Nipple variations, such as inverted nipples, retracted nipples, or other nipple changes, are often a cause of concern, but whether you should be alarmed or not depends vary much on the particular change you note. That said, it is a change in your nipples that is of greatest concern, and even if your nipples would be normal for someone else, you should always see your doctor if it is a change for you.
Inverted nipples are those that are not raised above the surface of the areola but appear sunken or indented. It is a congenital feature you are born with, as opposed to something that suddenly happens. As such, is not indicative of any medical problem. In contrast, if you are born with nipples that are elevated and they now appear to have flattened, especially if this has occurred on only one side, talk to your doctor.
Nipple inversion can also occur in later life as part of the normal aging process. Stimulation of the nipple can usually coax it out of hiding. When this occurs normally, it is usually equal on both sides, and the nipples feel flexible and freely mobile.
Retracted nipples, by contrast, are those which start out raised but then, for some reason, start to pull inward. This is not a normal response and may be an indication of a medical condition. Breast cancer is the primary concern, especially if the retraction is not bilateral (occurring in both breasts) and/or results in a change in a nipple’s position. You can also tell if there is a problem when stimulation doesn’t affect the nipple or areola in any way.
Abnormal Nipple Discharge
Nipple discharge may or may not be a problem depending on its appearance. A discharge will typically come out of the same ducts that carry milk and may be milky, clear, yellow, green, brown, or bloody. The consistency can also vary from thick and viscous or thin and watery.
Most nipple discharge occurring outside of pregnancy is benign, caused by a normal menstrual cycle, benign tumors called fibroadenomas, or lumps known intraductal papillomas which are typically noncancerous. A discharge caused by infection tends to be more pus-like in appearance with a greenish-yellow tinge.
Mammary duct ectasia is another cause of discharge and is most common around the time of menopause. The discharge is usually grey appearing and may have a green tint. It is also usually thick and sticky. This is a benign condition that occurs due to the milk ducts becoming swollen and clogged around the time of menopause.
Nipple discharge caused by breast cancer can often be tinged with blood and occur in one rather than both breasts. Intraductal papillomas may also cause bloody discharge, so it’s best to have it checked out whatever the cause.
Nipple Lumps and Bumps
Nipples and areolas can suddenly get become erect and feel bumpy when touched or exposed to cold. This is a perfectly normal response and one which typically resolves once the stimulation is removed. Changes like this can also happen during pregnancy when the bumps on the areola (called Montgomery glands) will suddenly engorge in preparation for breastfeeding.
However, if in the course of your monthly breast self-exam, you discover persistent bumps or lumps on or just beneath your nipple or areola, have them check out. It may be something as simple as a clogged milk duct, an intraductal papilloma, or a readily treatable infection. But it also may be the sign of a ductal carcinoma in situ, a highly treatable form of early-stage breast cancer.
To determine this, the doctor may opt to perform either a fine needle biopsy or an imaging test called ductography to evaluate the true nature of the lump.
Changes in Nipple and Areola Size
It is normal for your breasts and nipples to swell in response to your menstrual cycle or when you are pregnant or breastfeeding. The same can happen when using oral contraceptives.
However, if one breast grows noticeably larger, it is something you’ll definitely want looked at. Breast cancer can often cause asymmetrical changes in breast size, either suddenly or gradually. It may also be associated with mastitis, an infection of the breast tissue that occurs both in breastfeeding mothers and women who aren’t breastfeeding.
If, on the other hands, your breasts are normally asymmetrical, don’t worry—few of us are perfectly balanced. It is only a change in size that is concerning.
The easiest way to determine whether there is an actual enlargement or if you’re just going through your monthly cycle is to see how your bras fit. Do they suddenly fit tighter on one side or cause a pressure or discomfort that hasn’t been there before? If so, see a doctor.
Changes in Skin Texture and Color
During pregnancy, your breasts will change in response to hormones. As they prepare for breastfeeding, your nipples and areola will often become darker in color and your areola itself may become visibly larger.
When these changes occur outside of pregnancy, they are generally not considered normal. This can include the thickening of the skin, visible swelling or inflammation, an “orange peel” texture, a change of nipple direction, or noticeably warmer skin temperature.
The biggest concern is when the changes are either unilateral (occurring on one side) or unevenly distributed on both sides. Causes may include:
- Inflammatory breast cancer, a rare but rapidly spreading cancer that causes the swelling of the breasts. At first, this may appear to be eczema, but can rapidly spread and become red and tender.
- Squamous cell carcinoma, a common skin cancer associated with overexposure to the sun.
- Paget’s disease, a bone disorder that can also manifest with skin change. Like inflammatory breast cancer, Paget’s disease may also appear at first to resemble eczema.
- Eczema, an itchy skin inflammation with different possible causes.
- Bowen’s disease, a very early form of skin cancer that is easily treatable.
Outside of pregnancy or your menstrual cycle, there is no such thing as normal nipple pain. If you have persistent nipple tenderness, itchiness, or pain not caused by injury, you need to get it looked at.
While nipple pain is an uncommon symptom of breast cancer, it has, at times, been known to be the first symptom of a developing malignancy. On the other hand, if the pain is accompanied by swelling, redness, and warmth, it may a sign of mastitis or some other localized infection. Fibroadenoma or a benign cyst can also cause pain.
The two rules of thumb are this: Never ignore pain and become well acquainted with your breasts. If there are any changes that seem “off” to you, it is best to follow your instincts even if the symptoms are vague.
In most cases, it will be nothing (or at least nothing serious). And, even if it is, you stand a far better chance of successful treatment if the problem is spotted early. Simply put, early detection still saves lives.