Nipple Deformities · What Are They, Signs, Symptoms, and More

The majority of nipple deformities  are congenital (i.e., present at birth), but they can also develop later in life. Ordinarily, breast tissue arises from the milk lines, which are paired embryological structures that run from the armpits to the groin and originate from the ectodermal tissue, one of the three primary germ layers formed in early embryonic development.  

Typically, only the pectoral portion of the milk lines persists and develops into functional breast tissue, while the rest regresses. Remnants of the milk line that fail to regress can result in accessory nipples or breast tissue. This most often occurs just below the primary nipples, less commonly along the lower abdomen or groin, and in rare cases, in extramammary sites, such as the back, shoulder, thigh, face, or vulva.   

On the opposite end of the spectrum, severe ectodermal development defects can lead to the congenital absence of one or both breasts (i.e., amastia).  

Congenital nipple retractions or inversions may be caused by the shortening of the breast ducts during gestation.  Acquired nipple deformities typically develop later in life and can occur due to conditions that may disrupt the structure of the breast ducts, such as malignancy, inflammation, infection, trauma, or surgical procedures. 

Although nipple deformities rarely have a long-term effect on the function of the breasts, they may have a severe psychological impact on the individual, especially adolescents. Therefore, even though nipple deformities are usually managed with careful observation and do not require treatment, they may be managed differently if they cause significant distress or are symptomatic.  

Nipple inversions may be corrected non-surgically with suction devices in mild cases, or surgically in more severe or persistent cases. Accessory nipple or breast tissue may be removed for cosmetic reasons, and other deformities can be surgically reconstructed with plastic surgery when necessary. Reconstructive surgery by a plastic surgeon is typically performed when breast development is complete and final breast tissue volumes have been achieved. Treatment of athelia is similar to the nipple reconstruction procedures, with particular attention paid during reconstruction to the placement of the inframammary fold (i.e., the lower anatomical boundary of the breast) and re-creation of the nipple. The reconstructed nipple can be later tattooed to add color and to create the areola. 

When nipple deformities are acquired, it’s important to investigate the underlying cause, especially to identify and rule out malignancies. Changes in pigmentation may warrant early excision followed by histopathological assessment.