Any deformity of the nipples may be the cause of much anguish and embarrassment, however, the problem may extend beyond just the aesthetic aspect. An abnormal nipple or nipples may be linked to serious underlying disorders or structural defects that can affect the functioning of the nipple i.e. for breastfeeding.

Normally the nipple protrudes out from the surrounding areola on each breast. A woman may feel that her nipples are abnormal only because the two nipples appear to be different from each other, either in shape, size or color. Just as it is very common for a woman’s breasts to be asymmetrical in shape and size, so also the two nipples may vary slightly in their appearance and in such cases it is not considered as a deformity.

Types of Deformed Nipples and Causes

Trauma to the breast or nipple itself can lead to some nipple abnormalities. This has become common due to the popularity of nipple piercings these days which can lead to infection and/or scarring. Other cause like injury or burns may also cause disfigurement or loss of one or both nipples.

Inverted nipples

In this case the nipples are turned inwards into the areola but may come out on stimulation of the breast or during pregnancy and lactation. Breastfeeding may be a problem sometimes, but usually the nipples can be drawn out during breastfeeding if the baby can latch on properly or be means of a breast pump or other suction devices. Nipple inversion can occur on one breast (unilateral) or on both the breasts (bilaterla).

Causes

In a large number of cases, nipple inversion is a congenital defect (present at birth). It may also be related to :

  • Chromosome 2q deletion syndrome
  • Congenital disorder of glycosylation
  • Fryns-Aftimos syndrome
  • Genetically determined difference in the shape of nipple
  • Weaver syndrome
  • Kennerknecht-Sorgo-Oberhoffer syndrome

Retracted Nipples

Although the term “retracted nipples” is often used simultaneously with “inverted nipples”, these two conditions are not exactly the same. The nipples are said to be retracted when they were previously raised above the surface of the areola but now seem to be pulled inwards and do not come out on stimulation.

Causes

  • Breast cancer
  • Age-related changes
  • Duct ectasia
  • Infection of the milk duct
  • Trauma resulting in fat necrosis or scars
  • Post-operatively after breast or nipple surgery
  • Breast abscess
  • Mastitis
  • Tuberculosis
  • Sudden and excessive weight loss
  • Sagging breast

Prominent Nipples

The nipples may be unusually large and protruding. Protrusion may be seen during puberty in females and is temporary change due to the growth and development of the breasts (female sexual characteristics).

Causes

  • Pregnancy
  • Lactation
  • Puffy nipples, associated with tubular breast deformity, are caused by protrusion of the underlying breast tissue.

Polythelia (Third Nipple)

This is also known as supernumerary or accessory nipples where  there is the presence of an extra nipple. The additional nipple may be seen either above or below the normally situated nipple. In other cases, it may appear elsewhere on the body, usually along the “milk line” extending from the axilla to the inguinal region. It is a congenital malformation (birth defect).

Bifid nipples, intra-areolar polythelia, or dysplastic divided nipples are anatomic variants of the nipple on one or both sides but not an actual accessory nipple as with a supernumerary nipple.

Athelia

This is a rare congenital condition where there is absence of one or both nipples. It is a rare congenital anomaly, and is usually unilateral (one side) and may be associated with Poland syndrome. Bilateral athelia (absence of nipples on both breasts) may be seen in certain types of ectodermal dysplasia.

Other Nipple Abnormalities

  • Scaly, fissured or cracked nipples may be due to eczema, psoriasis, lactation, irritant dermatitis (jogger’s nipples), Paget’s disease.
  • Disproportionate size of the nipples in relation to the breast or areola is not usually a sign of any disease unless it suddenly develops and is associate with pain.
  • Imperforate nipples do not have openings on their surface for outflow of milk and may be related to trauma.


Article reviewed by Dr. Greg. Last updated on July 12, 2014