Nipple Retraction : Causes, Symptoms, Diagnosis & Treatment

• Why Does Nipple Retraction Occur?
• Inverted Nipples
• Mammary Cancer
• Breast Cancer In Men
• Fat Necrosis Of The Breast
• Other Reasons
• Diagnostics
• Treatment
• Conservative Therapy
• Surgery

Nipple retraction may be a feature of breast development. In the pathological variant, it is most often detected in breast cancer, in some cases it is found in other diseases. It can be combined with the appearance of discharge from the nipple, pain syndrome, deformities of the mammary gland. The cause of the symptom is established according to the survey, physical examination, sonography, mammography, and other instrumental and laboratory techniques. Treatment before diagnosis is not indicated.

Why does nipple retraction occur?

inverted nipples

A condition in which the nipples are at the same level with the areola or "pressed" into the gland is detected in every tenth woman in the population. There is a hereditary predisposition. Other possible causes are poor formation of the lactiferous ducts during puberty and congenital deficiency of the connective tissue that supports these ducts.

In most cases, the problem is aesthetic. If, when the nipple is squeezed at the base, it protrudes outward, retraction is considered a physiological norm. If it “goes” inside, it is considered as a violation. It may be difficult to feed the baby, especially in the case of inverted nipples (not protruding even during feeding and sexual stimulation).

Mammary cancer

With breast cancer, retraction is unilateral, it is not observed throughout life, but occurs in adulthood, as a rule, against the background of other changes in the mammary gland. It is found in the following forms of cancer:

• Paget's cancer. It affects the nipple-alveolar complex, so retraction is one of the typical early symptoms of the disease.
• Invasive ductal carcinoma. The most common form. It develops from the epithelial cells of the lactiferous ducts, sometimes diagnosed in women who have previously been successfully treated for other types of cancer.
• Hormone dependent. The second most common type of neoplasm. It has cells that are sensitive to female sex hormones, so tumor growth depends on cyclic changes.
• Triple negative. It does not have cells that respond to sex hormones. Rapid aggressive growth is typical for this neoplasia.
• Hereditary. Associated with certain genetic mutations. Women with this form of cancer often have relatives with the same disease. It often manifests at a young age, affects both mammary glands, or is combined with tumors of other localizations.
• In pregnant women. It develops during gestation, lactation, or during the first year after the birth of a child. In the early stages, the symptoms of a neoplasm are masked by physiological changes.

Along with retraction of the nipple, discharge, changes in the shape and shape of the mammary gland, wrinkling of tissues, purple or pink skin color, pain, and a feeling of discomfort can be observed. In the mammary gland, a seal is often palpated.

Nipple retraction

Breast cancer in men

A rare malignant tumor, usually occurring in older men with hyperestrogenism. Most often in male patients, invasive focal carcinoma and invasive ductal carcinoma are detected. In a significant number of cases, the neoplasm is located in the subareolar zone, which causes early involvement and retraction of the nipple. Men can also develop Paget's cancer, in which there is a primary lesion of the nipple.

Fat necrosis of the breast

Formed after chest injuries. The development of necrosis is preceded by the formation of a painful swelling. If the necrotic focus is localized near the nipple, its retraction may be detected. Subsequently, the normal tissue of the gland is not restored, the site of necrosis undergoes calcification, retraction can persist throughout life.

Other reasons

Sometimes retraction of the nipples is observed in pathologies such as:

• Intraductal papilloma. The appearance of a symptom is possible when a benign tumor is located near the exit of the lactiferous duct. Sometimes retraction is combined with discharge from the nipple.
• Tuberculosis of the breast. The symptom is rare. It may be associated with the formation of scars after the release of caseous masses and the closure of fistulas.
• Fibrocystic mastopathy. Retraction is due to the growth of connective tissue, which deforms the nipple-alveolar zone. Extremely rarely reaches a degree of severity that is noticeable to a non-specialist.

Diagnostics

The mammologist is engaged in clarifying the nature of the pathology that causes nipple retraction. The following diagnostic measures are recommended:

• Interrogation, external examination . The doctor establishes when the nipple retraction appeared, what symptoms it was accompanied by, how the disease developed. Examines and palpates the breast, evaluates changes in the nipple and mammary gland, detects deformities, determines the presence, size and localization of seals, examines regional lymph nodes.
• Ultrasonography. It has a higher information content in young patients. Visualizes neoplasms, necrosis zones, changes in the structure of the organ. Allows you to assess the condition of the milk ducts.
• Mammography. Reveals tumor nodes, subareolar microcalcifications, areas of fibrosis. It makes it possible to determine the thickness of the skin in the area of ​​the nipple and areola. According to the indications, it is supplemented with ductography and tomosynthesis.
• Other visualization methods . MRI is used to detect preclinical changes. Scintigraphy is prescribed to confirm the lesion of the ducts in Paget's cancer, to clarify the size, nature, localization and prevalence of nodes in all forms of oncological lesions.
• Biopsy of the breast. To take the material, a puncture, trephine biopsy or fine needle biopsy is performed. The tissue sample is sent for histological or cytological examination. Similar analyzes are carried out after obtaining a smear-imprint from the nipple of the breast.
• Laboratory Research . They are used to identify tumor markers, determine the level of female sex hormones, and assess the general condition of the body.

Surgical correction of an inverted nipple

Treatment

Conservative therapy

The tactics of conservative treatment will be determined by the nature of the pathology. With nipple retraction due to individual anatomical features, women are recommended to use vacuum nozzles. During the period of feeding a child, special pads can be used.

The main treatment for breast cancer is surgery, conservative methods are often indicated in the preoperative and postoperative period. With metastases to the lymph nodes, radiation therapy is performed. With a high risk of hematogenous and lymphogenous metastasis, cytostatics are used. The progression of hormone-dependent cancer is slowed down by prescribing drugs that reduce the effect of hormones on gland cells.

With fibrocystic dysplasia, tamoxifen and analogues are used, oral contraceptives are advised to normalize the menstrual cycle. The treatment regimen for tuberculosis includes anti-tuberculosis therapy, ultraviolet radiation, inductothermy, magnetotherapy, UHF, drug electrophoresis.

Surgery

Patients with retraction, not associated with other diseases, undergo plastic surgery to correct inverted nipples. If a woman plans to have children in the future, a microsurgical operation is performed, during which the connective tissue cords are dissected, and the milk ducts are preserved. If pregnancy is not planned, a dissection of the connective tissue along with the milk ducts is possible.

Areas of fat necrosis, intraductal papillomas and tuberculous foci are excised by sectoral resection. For cancerous tumors, the following operations are performed on the mammary gland:

• radical resection;
• oncoplastic resection;
• subcutaneous mastectomy;
• radical mastectomy;
• mastectomy with radiation;
• mastectomy with prosthetics;
• mastectomy with reconstruction with own tissues.