Breast skin and nipple changes

INVERTED NIPPLES

• This is normal if your nipples have always been indented inward and can easily point out when you touch them.
• If your nipples are pointing in and this is new, contact your provider right away.

SKIN PUCKERING OR DIMPLING

This can be caused by scar tissue from surgery or an infection. Often, scar tissue forms for no reason. See your provider. Most of the time this issue does not need treatment.

WARM TO THE TOUCH, RED, OR PAINFUL BREAST

This is almost always caused by an infection in your breast. It is rarely due to breast cancer. See your provider for treatment.

SCALY, FLAKING, ITCHY SKIN

• This is most often due to eczema or a bacterial or fungal infection. See your provider for treatment.
• Flaking, scaly, itchy nipples can be a sign of Paget disease of the breast. This is a rare form of breast cancer involving the nipple.

THICKENED SKIN WITH LARGE PORES

This is called peau d'orange because the skin looks like an orange peel. An infection in the breast or inflammatory breast cancer can cause this problem. See your provider right away.

RETRACTED NIPPLES

Your nipple was raised above the surface but begins to pull inward and does not come out when stimulated. See your provider if this is new.

Your provider will talk to you about your medical history and recent changes you have noticed in your breasts and nipples. Your provider will also do a breast exam and may suggest that you see a skin doctor (dermatologist) or breast specialist.

You may have these tests done:

• Mammogram
• Breast ultrasound
• Biopsy
• Other tests for nipple discharge

Contact your provider if you notice:

• Your nipple is retracted or pulled in when it was not that way before.
• Your nipple has changed in shape.
• Your nipple becomes tender and it is not related to your menstrual cycle.
• Your nipple has skin changes.
• You have new nipple discharge.
• You notice bleeding from the nipple.
• You have fever and breast tenderness or pain.

Inverted nipple; Nipple discharge; Breast feeding - nipple changes; Breastfeeding - nipple changes

David BA, Shalin SC. Disorders of the skin. In: Klimberg VS, Gradishar WJ, Bland KI, Korourian S, White J, Copeland EM, eds. Bland and Copeland's The Breast: Comprehensive Management of Benign and Malignant Diseases. 6th ed. Philadelphia, PA: Elsevier; 2024:chap 18.

Deb S, Dabbs DJ, Fox SB. Neoplasia of the male breast. In: Dabbs DJ, ed. Breast Pathology. 3rd ed. Philadelphia, PA: Elsevier; 2024:chap 32.

Klatt EC. The breasts. In: Klatt EC, ed. Robbins and Cotran Atlas of Pathology. 4th ed. Philadelphia, PA: Elsevier; 2021:chap 14.

Updated by: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 05/22/2024.