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Symptoms – Nipple Changes or Discharge

Breast cancer may cause changes to the nipple, including causing the nipple to face inward (inverted), causing changes to the skin on the nipple or areola (the darkened skin around the nipple), or causing a discharge from the nipple. Any discharge or changes to the shape or appearance of the nipple should be discussed with a healthcare professional.1

Anatomy of the nipple

The nipple projects from the center of the areola, the darkly pigmented area in the breast. Milk ducts connect the milk glands deep in the breast to the nipple. Under the areola is a thin layer of muscle and connective tissue.2

Changes to the shape of the nipple

Some breast cancers can cause the nipple to turn inward. This is called an inverted nipple or a retracted nipple. Certain people have inverted nipples naturally – their breasts develop this way. However, if the nipple changes and turns inward, it should be checked by a doctor.3

Changes to the skin around the nipple

One rare form of breast cancer, called Paget disease of the nipple, can cause changes to the skin of the nipple and areola. The skin may appear scaly, dry, flaky, red, or crusty. The nipple and areola may have a burning or itching sensation. Paget disease can also cause nipple inversion. Any of these changes should be checked by a doctor.4

Nipple discharge

When the nipple has a discharge or fluid that comes from it, it may be different colors or textures, and it may be bloody. The discharge is different than breast milk, which naturally develops after a pregnancy.1

Most of the time, nipple discharge is due to a non-cancerous (benign) cause. However, any discharge should be brought to the attention of a doctor. The doctor will typically ask if the discharge is coming from both breasts or just one, and ask what medications the patient is taking, as some medications may cause nipple discharge. He or she will also note the color of the discharge and may order additional tests.5

Other symptoms of breast cancer

Besides changes to the nipple, breast cancers may cause other symptoms, such as6:

Follow-up tests

To diagnose whether changes to the breast are caused by breast cancer or another cause, several tests may be performed, including4,5:

  1. Understanding breast changes. National Cancer Institute. Available at https://www.cancer.gov/types/breast/breast-changes/understanding-breast-changes.pdf. Accessed 7/30/18.
  2. Zucca-Matthes G, Urban C, Vallejo A. Anatomy of the nipple and breast ducts. Gland Surgery. 2016;5(1):32-36. doi:10.3978/j.issn.2227-684X.2015.05.10.
  3. Breast skin and nipple changes. Medline Plus, U.S. National Library of Medicine. Available at https://medlineplus.gov/ency/patientinstructions/000622.htm. Accessed 7/31/18.
  4. Paget disease of the nipple. American Cancer Society. Available at https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/types-of-breast-cancer/paget-disease-of-the-nipple.html. Accessed 7/31/18.
  5. Salzman B, Fleegle S, Tully AS. Common breast problems. Am Fam Physician. 2012 Aug;86(4):343-349. https://www.aafp.org/afp/2012/0815/p343.html.
  6. Breast cancer treatment (PDQ). National Cancer Institute. Available at https://www.cancer.gov/types/breast/patient/breast-treatment-pdq. Accessed 7/30/18.