Nipple retraction
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.
History and physical examination
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? 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.
Medical causes
Breast abscess
Breast abscess, most common in breast-feeding women, 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
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.
Other causes
Surgery
Previous breast surgery may cause underlying scarring and retraction.
Special considerations
Prepare the patient for diagnostic tests, including mammography, cytology of nipple discharge, and biopsy.
Pediatric pointers
Nipple retraction doesn’t occur in prepubescent females.
Pictures
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Breast pain
Read excerpts from these other book chapters related to Breast pain:
Medical Books Excerpts
- Nipple Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Breast pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Breast pain
» Next page: Breast pain [Mastalgia] (Handbook of Signs & Symptoms (Third Edition))
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