Nipple inversion and retraction

Nipple inversion and retraction

At birth the mammary glands in boys and girls are similar. At around 11–12 years of age, in girls the breast begins to grow . The onset of its growth is called ‘the telarche’ (1 year before menarche). Initially uniform growth of cells leads to a rounded breast mound. Later elongation of the major milk ducts at age 14–16 years leads to projection of the nipple. Lack of elonga tion of the major milk ducts leads to failure of the nipple to protrude, called nipple inversion ( Figure 58.17 ). An inverted nipple interferes with feeding and may become a source of infection by deposition of debris. It does not pr edispose to breast cancer. Nipple retraction is an acquired phenomenon owing to fibrosis in and around the major milk ducts. Retraction of recent onset is always worrisome and may point towards an underlying carcinoma; howev er, the most common cause of longstanding retraction is periductal mastitis ( Figure 58.18 Both nipple inversion and retraction may cause prob lems with breastfeeding and infection can occur because of retention of secretions. A transverse slit-like or fish mouth-like retraction of the nipple is classically seen in periductal mastitis ( Figure 58.18a ), but circumferential retraction may indicate a car cinoma ( Figure 58.18b ) . - - - - ). -

Figure 58.17 Congenital nipple inversion. (a) (b) Figure 58.18 Two common causes of retraction of the nipple. (a) Slit- like retraction due to periductal mastitis. (b) Breast cancer with /f_i brosis around the major milk ducts.

Minor degrees of inversion can be corrected by gently pulling the nipple forward. Surgical correction is fraught with division of milk ducts and loss of nipple sensation and the patient should be fully informed of this risk. Mechanical suction devices have been used to evert the nipple, with some benefit.