Nipple inversion describes the nipple retracting inward instead of projecting outward. A sudden or newly acquired inversion, especially if it affects only one nipple, represents a change in breast anatomy that warrants attention. Understanding the underlying reasons is important, as it can indicate various physiological processes within the breast tissue.
Differentiating Nipple Inversion
It is important to distinguish between nipple inversion that has always been present and a new onset of the condition. Many individuals are born with naturally inverted nipples, a state known as congenital inversion. This type of inversion is often present from birth or develops during puberty, typically affects both nipples, and does not usually signify an underlying health concern.
In contrast, sudden or acquired nipple inversion refers to a situation where a previously everted nipple begins to retract. This change suggests a recent alteration in the underlying mammary structures. This distinction is important because new-onset inversion often prompts medical evaluation.
Common Explanations for Sudden Inversion
Several conditions can lead to sudden nipple inversion, ranging from benign changes to more serious concerns. One common benign cause is mammary duct ectasia, where the milk ducts beneath the nipple widen, their walls thicken, and they can become inflamed. As these ducts shorten and scar, they can pull the nipple inward, often affecting perimenopausal or postmenopausal women.
Another benign inflammatory condition, periductal mastitis, involves inflammation and infection of the tissue surrounding the milk ducts. This can lead to fibrous tissue formation, which then contracts and pulls on the nipple. Fat necrosis, which occurs when fatty breast tissue is damaged, can also cause nipple retraction as the damaged fat forms a scar-like lump that contracts surrounding structures.
Breast surgery or significant trauma can also result in scar tissue formation that pulls the nipple inward. The natural aging process can contribute to nipple inversion due to changes in the connective tissues and ducts within the breast, causing duct shortening.
While many causes are benign, sudden nipple inversion can also be a sign of breast cancer. Certain types of breast cancer can cause the nipple to retract when the tumor grows within or near milk ducts, or causes inflammation and fibrosis that pulls the nipple inward.
When to Consult a Healthcare Professional
Any new or sudden nipple inversion, especially if it affects only one nipple, warrants prompt medical evaluation. This change should not be ignored, even if no other symptoms are present.
It is particularly important to seek medical attention if nipple inversion is accompanied by other symptoms. These include a new lump or thickening in the breast, any nipple discharge (especially if bloody, clear, or spontaneous), or changes in the skin of the breast or nipple. Skin changes might include dimpling, redness, scaling, or a rash. Pain or tenderness in the breast also suggests immediate consultation.
The Diagnostic Process
Investigation of sudden nipple inversion typically begins with a thorough clinical breast examination. The doctor will visually inspect the breasts and nipples and manually feel for lumps, thickening, or other abnormalities in the breast tissue and armpit lymph nodes.
Following the physical examination, imaging tests are commonly performed to visualize internal breast structures. A mammogram is often the first step. An ultrasound may also be used for specific areas, particularly if a lump is felt or if the patient has dense breast tissue. In some cases, an MRI scan might be recommended for a comprehensive view.
If imaging tests reveal a suspicious area, a biopsy will likely be performed. This involves taking a tissue sample from the suspicious area, often guided by ultrasound or mammography, for microscopic examination. A biopsy is the only way to definitively determine if the changes are benign or malignant.