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 retraction of the nipple. 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 for 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, and with her arms overhead; and with the patient 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.
A breast abscess, most common in breast-feeding women, occasionally produces unilateral nipple retraction. More common findings include high fever with chills; breast pain, erythema, and tenderness; breast induration or soft mass; and cracked, sore nipples, possibly with purulent discharge.
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.
Nipple retraction commonly occurs in mammary duct ectasia, 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.
Nipple retraction, deviation, cracking, or flattening may occur in mastitis, along with a firm and indurated or tender, flocculent, discrete breast nodule; warmth; erythema; tenderness; and edema. Fatigue, high fever, and chills may also be present.
Previous breast surgery may cause underlying scarring and retraction.
Prepare the patient for diagnostic tests, including mammography, cytology of nipple discharge, and biopsy.
Nipple retraction doesn’t occur in prepubescent females.
Teach your patient breast self-examination, and advise her to always seek medical evaluation for breast changes.
Read excerpts from these other book chapters related to Inverted nipple/nipple retraction:
Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1 
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