Why does the nipple go inward?
The nipple is held in an elevated position by smooth muscles and connective tissue cords, and milk ducts enter it from the inside. If the ducts are shortened or the cords are too dense, the nipple is retracted - this is how a congenital variant is formed, usually noticeable from puberty. Acquired retraction occurs when the tissue inside the gland shortens or tightens the nipple: with scarring after inflammation, after surgery, with dilation and inflammation of the ducts around menopause, as well as with the growth of a tumor that pulls on the ligaments.
- Congenital shortness of ducts and cords
- Scars after mastitis or abscess
- Consequences of breast surgery
- Dilation and inflammation of the ducts in perimenopause
- Age-related changes in gland tissue
- Tumor tightening the ligaments of the gland
Degrees and types
Doctors evaluate how easily the nipple comes out. In the first degree, it comes out with slight squeezing of the areola and is held for some time; Such nipples usually do not interfere with feeding. In the second degree, the nipple is pulled out with force and immediately returns back. With the third, it is not removed at all, there is often maceration and diaper rash in the fold, and breastfeeding without the help of a specialist can be difficult. They evaluate separately whether both glands are affected: a bilateral symmetrical picture often indicates a congenital feature.
- First degree - the nipple is easily removed
- Second degree - withdrawn with force and retracted back
- Third degree - not displayed
- Flat nipple as a separate option
- Bilateral retraction - most often congenital
- Unilateral recent retraction - requires examination
When is this a warning sign?
The main criterion is not the fact of retraction itself, but its novelty and one-sidedness. If a woman has lived with such nipples all her life, the likelihood of a serious cause is low. If the nipple has retracted in recent months, changed direction, and a lump, skin changes, discharge from the nipple, or enlarged lymph nodes in the armpit have appeared nearby, an examination is necessary to rule out a tumor. A non-healing crust or weeping on the nipple requires special attention: a special form of cancer may be hidden under this picture, so it cannot be treated with ointments at random.
- Recent onset of retraction
- Unilateral change
- Seal in the gland
- Discharge from the nipple, especially bloody
- Changes in the skin over the gland
- Enlarged axillary lymph nodes
- Weeping crust on the nipple and areola
Survey
They start with examining and palpating the glands and lymph nodes. Women under 40 years of age are usually prescribed an ultrasound examination, after 40 years - a mammogram, and, if necessary, both methods. If a compaction or structural change is found, a biopsy with histological examination is performed - this is the only way to make an accurate diagnosis. If there is discharge from the nipple, your doctor may recommend testing the ducts. If the picture is typical for a congenital variant and there are no warning signs, the examination is limited to examination and routine age-related screening.
- Inspection and palpation of glands and lymph nodes
- Ultrasound of the mammary glands
- Mammography after 40 years and according to indications
- Biopsy of the formation with histology
- Examination of nipple discharge
- MRI of the mammary glands in complex cases
- Scraping or biopsy for changes in the skin of the nipple
What to do and how to treat
Congenital retraction without complaints does not require treatment. Women planning to breastfeed are helped by preparation and correct latching technique: in many cases, the baby successfully latch onto the breast, and if there are difficulties, they use special pads, pumping and the help of a lactation consultant. It is important to carefully care for the skin fold to avoid diaper rash and inflammation. In case of pronounced retraction, which interferes and worries, surgical correction is possible - it is discussed with a mammologist. When acquired retraction, the cause is treated.
- Observation for congenital form without complaints
- Preparation and proper latching technique when feeding
- Using pads and pumping for difficulties
- Hygiene and prevention of diaper rash in the fold
- Surgical correction for severe retraction
- Treatment of the main cause in the acquired form
- Regular breast screening according to age