Nipple retraction

Nipple retraction: Excerpt from Handbook of Signs & Symptoms (Third Edition)

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.

More About Breast Cancer

• Back to disease: Breast Cancer: Introduction
• Next Book Extract About Breast Cancer: Peau d'orange (Handbook of Signs & Symptoms (Third Edition))
• More Book Extracts: All Online Books for Breast Cancer

More Medical Textbooks Online about Breast Cancer

Review other book chapters online related to Breast Cancer:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1

 » Next page: Peau d'orange (Handbook of Signs & Symptoms (Third Edition))

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Peau d'orange (Handbook of Signs & Symptoms (Third Edition))
• Breast nodule [Breast lump] (Handbook of Signs & Symptoms (Third Edition))
• Galactorrhea/Nipple Discharge (A Pocket Manual of Differential Diagnosis)
• Introduction: Malignant Neoplasms (Professional Guide to Diseases (Eighth Edition))
• Breast cancer (Professional Guide to Diseases (Eighth Edition))

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City