Nipple Up Nuts

Nipple Up Nuts

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Serenity Mirabito, MSN, RN, OCN, is a published oncology nurse writer who advocates for those surviving and thriving with cancer.
Chioma Ndubisi, MD, is a board-certified OB/GYN who specializes in sexual and reproductive health in New York, New York.

The nipple is a protuberance (bump) of tissue found on the breast from which milk flows during breastfeeding. Just as breasts come in all shapes and sizes, so do nipples.

Although most people have protruding nipples, approximately 10%–20% have inverted nipples. 1 Flat nipples are another possible variation.

In addition to different shapes and sizes, nipples can point forward, to the side, or downward. People can have hairy nipples and sometimes extra nipples. Understanding that these differences are normal may come as a relief since people can be self-conscious about their nipples.

This article will explain normal variations in nipple types and describe when to call your healthcare provider with concerns.

Although protruding nipples are the most common type, their exact shape can vary from person to person. One study found that the average height of a nipple is 0.9 centimeters, or one-third of an inch. 2 Protruding nipples can become more erect if exposed to the cold, stimulated by touch, or during sexual arousal.

The nipple is surrounded by a pigmented circle called the areola. Depending on a person's skin tone, it may be pink to brown in color. The areola has glands that lubricate the nipple to help with breastfeeding.

It's important to become familiar with the usual shape and size of your nipples so you can report any changes to your healthcare provider.

About 1%–5% of people have an extra nipple or nipples. This is known as supernumerary nipples . 3 These extra nipples don't cause harm or need to be removed.

Instead of protruding, inverted nipples are tucked below the skin's surface. As a result, they can appear dented or sucked in. Nipple inversion is usually a congenital condition (one you're born with).

Inverted nipples result from shortened milk ducts that pull the nipple tissue inward. 3 Nipple protrusion can occur with inverted nipples, especially when they are being stimulated. Some inverted nipples, however, will never protrude. 1 Although harmless, inverted nipples can make breastfeeding difficult.

Protruding nipples that suddenly become inverted, especially on one breast, could be a sign of breast cancer and should be evaluated by your healthcare provider.

Some women are self-conscious about how their inverted nipples look. Here are some options for reversing inverted nipples:

Flat nipples are not raised or inverted—they lay even with the areola. Some flat nipples will always remain flat, and some will become erect with cold temperatures, stimulation, or sexual arousal.

Women with flat nipples who plan to breastfeed may experience some difficulty. Mothers can try gently pulling the nipple forward and rolling it between their fingers to cause the nipple to protrude. Using a breast pump for a few seconds before breastfeeding can also help pull the nipples forward. 5

Nipples that originally protruded but begin to pull inward, change position, or fold into a narrow crease are called acquired retracted nipples. A retracted nipple, unlike an inverted nipple, will not protrude when stimulated.

Nipple retraction may result from aging, duct ectasia (when milk ducts become swollen and clogged), or breast cancer. 6 A mammogram, breast ultrasound , or breast magnetic resonance imaging (MRI) scan will help diagnose the cause of the nipple change and guide your treatment. 7

Hair follicles surround the nipples, so it's normal to have a few strands grow there. However, plucking or tweezing around your nipple can cause ingrown hairs and infected follicles. Shaving can increase the risk of ingrown hairs. Cutting the hair is a better option.

If there are more than just a few hair strands around your nipples and you notice hair growth in other areas (like your face), this is a condition known as hirsutism .

Causes of excessive hair growth include:

See your healthcare provider if you notice excessive or icreased hair growth around your nipples or other areas of your body.

Although most people have protruding nipples, they can vary in appearance. Flat and inverted nipples are variations that people are born with or that can develop due to aging. During puberty, pregnancy, and menopause, hormonal fluctuations can affect nipple appearance and sensitivity.

A few hair strands around the nipple are normal, but excessive hair growth can be caused by certain medical conditions. Notify your healthcare provider of any nipple changes, especially if they occur suddenly or on only one side.

Variations in nipple shape are common. Changes in nipple shape can signify breast cancer. Becoming familiar with how your nipples typically look and feel is important so you will notice changes right away. Doing a monthly breast self-exam is one way to do this. Nipple inversion, pain, leaking, or swelling in one breast should be reported to your healthcare provider immediately. If caught early, breast cancer is treatable, and often curable.

Many women worry that the size or shape of their nipples will make breastfeeding impossible. While flat and inverted nipples may make breastfeeding challenging, some devices and techniques help babies easily latch on to the breast. A lactation consultant can be helpful for breastfeeding mothers.

There are three common types of nipples: protruding, flat, and inverted. Each of these variations can vary in appearance from person to person.
Having protruding nipples may help the baby latch onto the breast more easily, but with the support of a lactation consultant, successful breastfeeding is possible with any type nipple.
Nagaraja Rao D, Winters R. Inverted nipple. StatPearls.
Sanuki J ichi, Fukuma E, Uchida Y. Morphologic study of nipple-areola complex in 600 breasts. Aesth Plast Surg . 2009;33(3):295-297. doi: 10.1007/s00266=088-9194-y.
Zucca-Matthes G, Urban C, Vallejo A. Anatomy of the nipple and breast ducts . Gland Surg . 2016;5(1):32-6. doi:10.3978/j.issn.2227-684X.2015.05.10
Yukun L, Ke G, Jiaming S. Application of nipple retractor for correction of nipple inversion: A 10-year experience . Aesthetic Plast Surg. 2016. 40(5):707-15. doi:10.1007/s00266-016-0675-0
Schavelzon D, Mussi Becker M, Blugerman GA, Blugerman G. Chandler's modified technique for simple correction of inverted nipple deformities . In: Shiffman MA, ed. Nipple-Areolar Complex Reconstruction: Principles and Clinical Techniques . New York: Springer International Publishing; 2018.
Moon JY, Chang YW, Lee EH, Seo DY. Malignant invasion of the nipple-areolar complex of the breast: usefulness of breast MRI . AJR Am J Roentgenol. 2013;201(2):448-55. doi:10.2214/AJR.12.9186
McCartney CR, Marshall JC. Clinical practice. Polycystic ovary syndrome . N Engl J Med . 2016;375(1):54–64. doi:10.1056/NEJMcp1514916
National Institute of Diabetes and Digestive and Kidney Diseases. Cushing's syndrome .

By Serenity Mirabito RN, OCN

Serenity Mirabito, MSN, RN, OCN, advocates for well-being, even in the midst of illness. She believes in arming her readers with the most current and trustworthy information leading to fully informed decision making.

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