Nipple retraction, the inward displacement of the nipple below the level of surrounding breast tissue, may indicate an inflammatory breast lesion or cancer. It results from scar tissue formation within a lesion or large mammary duct. As the scar tissue shortens, it pulls adjacent tissue inward, causing nipple deviation, flattening and, finally, retraction.
Ask the patient when she first noticed the nipple retraction. Has she experienced other nipple changes, such as itching, discoloration, discharge, or excoriation? Has she noticed breast pain, lumps, redness, swelling, or warmth? Has she had a fever? Obtain a history, noting risk factors of breast cancer, such as a family history or previous malignancy.
Carefully examine both nipples and breasts with the patient sitting upright with her arms at her sides; with her hands pressing on her hips; with her arms overhead; and leaning forward so her breasts hang. Look for redness, excoriation, and discharge; nipple flattening and deviation; and breast asymmetry, dimpling, or contour differences. (See Differentiating nipple retraction from inversion.)
Try to evert the nipple by gently squeezing the areola. With the patient in a supine position, palpate both breasts for lumps, especially beneath the areola. Mold breast skin over the lump or gently pull it up toward the clavicle, looking for accentuated nipple retraction. Also, palpate axillary lymph nodes.
Breast abscess.Breast abscess occasionally produces unilateral nipple retraction. More common findings include a high fever with chills; breast pain, erythema, and tenderness; breast induration or a soft mass; and cracked, sore nipples, possibly with a purulent discharge.
Breast cancer.With breast cancer, unilateral nipple retraction is commonly accompanied by a hard, fixed, nontender nodule beneath the areola as well as other breast nodules. Other nipple changes include itching, burning, erosion, and watery or bloody discharge. Breast changes commonly include dimpling, altered contour, peau d'orange, ulceration, tenderness (possibly pain), redness, and warmth. Axillary lymph nodes may be enlarged.
Mammary duct ectasia.Nipple retraction commonly occurs along with a poorly defined, rubbery nodule beneath the areola, with a blue-green skin discoloration; areolar burning, itching, swelling, tenderness, and erythema; and nipple pain with a thick, sticky, grayish, multiductal discharge.
Mastitis.Nipple retraction, deviation, cracking, or flattening may occur in mastitis with a firm and indurated or tender, flocculent, discrete breast nodule; warmth; erythema; tenderness; and edema. Fatigue, high fevers, and chills may also be present.
Surgery.Previous breast surgery may cause underlying scarring and retraction.
▪ Prepare the patient for diagnostic tests, including mammography, cytology of nipple discharge, and biopsy.
▪ Teach the patient to perform monthly breast self-examination.
▪ Advise the patient to seek medical attention for breast changes.
▪ Explain the cause of the nipple retraction and the treatment plan.
Read excerpts from these other book chapters related to Breast dimpling:
Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
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Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7 
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