Many factors can alter the appearance, shape, or texture of the nipple and areola. Sometimes these changes are temporary and are due to hormonal changes, pregnancy or breastfeeding. Permanent changes to the nipple or areola are often seen with breast surgery, weight loss, and aging. It is important to familiarize yourself with the normal condition of your breasts and report any changes to your healthcare provider.
This article will discuss normal and abnormal changes to the nipple and areola.
Breast anatomy is complex and intricate
Nipples and areolas vary in size. The areola is the pigmented, circular area around the nipple, usually between 3 cm and 6 cm (1.2 inches to 2.4 inches). Nipple and areola size is sometimes related to breast size, but genes may also play a role. It is normal for the size of the nipple and areola to change during puberty, certain stages of the menstrual cycle, pregnancy, and breastfeeding.
Tell your healthcare provider if you experience any changes in the texture of your nipple or areola (such as orange peel), skin condition (ulcers), or pain.
The areola is usually darker than the nipple itself. It can range from pale pink to dark brown depending on your skin tone. Hormonal changes (menstrual cycle and menopause), breast surgery, pregnancy and breastfeeding can cause changes in the color of the nipple and areola. As hormones normalize and after pregnancy, the color will return to near normal.
A nipple that turns red, purple, or dark purple in color, especially if it is accompanied by itching or drainage, should be reported to your healthcare provider right away.
When to call your healthcare provider
Changes in the nipple and areola of one breast are more worrisome than changes in both. However, you should report any unusual changes to your healthcare provider.
The skin texture of the nipple is usually smooth, while the areola may be bumpy and pimple-like. The Montgomery glands are responsible for lubricating the nipple and areola, which are raised areas on the areola, during breastfeeding. Eczema is a treatable rash that changes the texture of the areola.
Thickening, redness, swelling, and warmth of the skin can be signs of serious conditions such as inflammatory breast cancer or Paget’s disease of the nipple. Notify your healthcare provider if you have these symptoms.
Your nipples usually get erect when you touch or are exposed to cold. The areola may also become firmer. During pregnancy, the Montgomery glands enlarge in preparation for breastfeeding. As a result, the glands can become blocked, leading to infection. A blocked Montgomery gland can be treated with antibiotics and home remedies.
If you are not pregnant and develop any new lumps or bumps, you should see a healthcare provider.
It is normal to have a few hairs on the areola. However, plucking or pinching the areola with tweezers can lead to ingrown hairs and infection of the follicles. Cutting or shaving are better options.
It is not uncommon to have more than a few strands of hair on each areola. More hair than this can be a sign of polycystic ovary syndrome (PCOS).
PCOS is a hormonal imbalance (when there are more androgens, male hormones than typical) that can lead to infertility. Symptoms include:
- weight gain
- irregular period
Talk to your healthcare provider if you notice increased hair growth on your breasts.
Although nipple discharge is uncommon, it’s not always abnormal. It can be caused by hormonal changes or pregnancy.
Nipple discharge is usually released from the milk ducts and may be:
The consistency can vary from thick and sticky to thin and watery. If benign (harmless), the discharge usually comes from both breasts. Fluid may leak spontaneously or only when the breast is squeezed or irritated.
Milky discharge is normal during pregnancy as the breasts are preparing to produce milk. Sometimes, certain phases of the menstrual cycle lead to discharge.
Other causes of nipple discharge include:
- Dilated milk ducts: blocked or swollen milk ducts
- Galactorrhea: A discharge that resembles breast milk but occurs when not breastfeeding
- Intraductal papilloma: called a benign tumor fibroadenoma
Nipple discharge is more likely to be associated with breast cancer when:
- it’s spontaneous
- is it bloody or clear
- fluid draining from one nipple
- you have other symptoms, such as lumps, sore nipples, or changes in skin texture
What type of nipple discharge do you have?
Some nipple pain is normal or expected. For example, it is common for your breasts and nipples to be sore before your period. Also, breastfeeding can cause hard, cracked, and bleeding nipples.
A 2018 study estimated that 80%–90% of breastfeeders experience sore nipples at some point.
Several benign and treatable conditions associated with nipple pain include:
- mastitis (breast infection)
- Nipple yeast infection
Raynaud’s phenomenon can cause vasoconstriction in the nipple, leading to episodes of pain, burning, and/or tingling. This can happen when:
- exposed to cold
- nipple trauma
In rare cases, nipple pain is a symptom of breast cancer, especially Paget’s disease of the nipple.
Consult your healthcare provider if you have:
- persistent nipple tenderness
- pain for no apparent reason
Some people’s nipples are more sensitive than others. Therefore, they may be irritated by certain laundry detergents or fabrics. For example, distance runners are more likely than non-athletes to experience sore nipples from abrasions. Wear a fitted, breathable cotton bra to reduce chafing. Using a cleanser for sensitive skin can also help prevent nipple irritation and sensitivity.
Sexual arousal is another cause of sensitive nipples. This is because the brain registers nipple stimulation as a sexual act.
Causes of sore nipples
Nipple variations are usually what people are born with. They include inverted nipples, also known as retracted nipples. Inverted nipples look sunken or sunken. They can also occur as part of the normal aging process, usually on both sides.
Talk to your healthcare provider if your nipple has ever protruded and suddenly flattened, especially on one side. In some cases, this can be a sign of breast cancer.
Are your nipples normal?
Inverted nipples can make breastfeeding difficult. The baby’s mouth usually firmly grips part of the protruding nipple and areola, which stimulates milk production. Certain techniques and devices, such as nipple shields, can improve breastfeeding success. You may also want to consult a lactation consultant for further support.
having extra nipples is called non-staff nipples or leafy. An estimated 0.2% to 2.5% of the population suffers from leafy plants. This condition is considered a mild birth defect.
The extra nipple is usually small and lower than the breast. Therefore, they may not be noticed until puberty or pregnancy. Excess nipples are benign and do not require treatment or removal.
Nipples and areolas vary in size, shape, color, and texture. It is important to be familiar with the appearance of the nipple and areola. Sudden changes in appearance should be reported to your healthcare provider immediately.
Other problems, such as excessive hair growth, leaky nipples, sudden retraction or inverted nipples, also need to be evaluated. While these changes may be normal, depending on hormonal changes, pregnancy, or aging, they can also be signs of serious illness or disease.
Many women are self-conscious about the appearance of their nipples and areola. While undergoing breast surgery to correct the perceived problem is one solution, so is practicing body positivity. Genetics and ethnicity play an important role in how nipples and areolas appear. Learning to love and respect these differences is important for self-esteem and confidence.
It is normal for the nipples and areola to change from puberty to menopause. However, sudden or one-sided changes must be reported to your healthcare provider immediately.
Frequently Asked Questions
What are the five stages of breast development?
According to Tanner stages, the five stages of breast development are:
- Stage 1: No palpable glandular breast tissue
- Stage 2: Palpable breast buds under the areola (first sign of puberty in women)
- Stage 3: Extra-areola palpable breast tissue; no field development
- Stage 4: The areola rises above the breast contour, creating a “double scoop” appearance
- Stage 5: Recession of areola mounds into single breast contour, areola hyperpigmentation, nipple development and nipple protrusion
What hormones cause nipple changes?
Hormones called estrogen are responsible for changes in the nipple, areola, and breasts.
When should your nipples be fully developed?
Generally, breasts begin to develop between the ages of 8 and 13. Usually, female breasts are fully developed between the ages of 17 and 18. However, they can continue to grow into their early 20s.