Nipple retraction may be a feature of breast development. In the pathological variant, it is most often detected with breast cancer, in some cases it is detected with other diseases. It can be combined with the appearance of a discharge from the nipple, pain syndrome, deformities of the breast. The cause of the symptom is determined according to the survey, objective examination, sonography, mammography, and other instrumental and laboratory techniques. Treatment before the diagnosis is determined is not indicated.
Causes of nipple retraction
A condition in which the nipples are on the same level with the areola or “pressed” into the gland is detected in every tenth woman in the population. Hereditary predisposition is visible. Other possible causes are weak formation of the milky ducts during puberty and congenital insufficiency of the connective tissue supporting these ducts.
In most cases, the problem is aesthetic in nature. If, when the nipple is squeezed at the base, it protrudes outward, retraction is considered a physiological norm. If it “goes” inside, it is considered as a violation. There may be difficulties when feeding the baby, especially in the case of inverted nipples (not protruding even during feeding and sexual stimulation).
With breast cancer, the retraction is unilateral, it is not observed throughout life, but occurs in adulthood, as a rule, against the background of other breast changes. It is found in the following forms of cancer:
- Paget’s cancer. It affects the nipple-alveolar complex, so retraction is one of the typical early symptoms of the disease.
- Invasive ductal carcinoma. The most common form. It develops from the epithelial cells of the milky ducts, and is sometimes diagnosed in women who have previously been successfully cured of other types of cancer.
- Hormone-dependent. The second most common type of neoplasm. It has cells sensitive to female sex hormones, so the growth of the tumor depends on cyclic changes.
- Three times negative. It has no cells that respond to sex hormones. Rapid aggressive growth is typical for this neoplasia.
- Hereditary. It is associated with certain genetic mutations. Women with this form of cancer often have relatives suffering from the same disease. It often manifests at a young age, affects both mammary glands or is combined with tumors of other localizations.
- In pregnant women. It develops during gestation, lactation, or during the first year after the birth of a child. In the early stages, the symptoms of neoplasm are masked by physiological changes.
Along with the retraction of the nipple, there may be discharge, changes in the shape and outline of the breast, wrinkling of tissues, purple or pink skin color, pain, a feeling of discomfort. A seal is often felt in the breast.
Breast cancer in men
A rare malignant tumor, usually occurring in elderly men with hyperestrogenism. Most often, invasive focal cancer and invasive ductal carcinoma are detected in male patients. In a significant number of cases, the neoplasm is located in the subareolar zone, which causes early involvement and retraction of the nipple. Men can also develop Paget’s cancer, in which there is a primary lesion of the nipple.
Fatty necrosis of the breast
It is formed after chest injuries. The development of necrosis is preceded by the formation of painful swelling. If the necrotic focus is localized near the nipple, its retraction may be detected. Subsequently, the normal tissue of the gland is not restored, the necrosis site is calcified, the retraction can persist throughout life.
Sometimes nipple retraction is observed with pathologies such as:
- Intra-current papilloma. The appearance of the symptom is possible when a benign tumor is located near the outlet of the milky duct. Sometimes the retraction is combined with discharge from the nipple.
- Tuberculosis of the breast. The symptom is rarely detected. It may be associated with the formation of scars after the release of caseous masses and the closure of fistulas.
- Fibrocystic mastopathy. The retraction is caused by the growth of connective tissue, which deforms the nipple-alveolar zone. Extremely rarely reaches a degree of severity noticeable to a layman.
A mammologist is engaged in clarifying the nature of the pathology that causes nipple retraction. The following diagnostic measures are recommended:
- A survey, an external examination. The doctor determines when the nipple retraction appeared, what symptoms it was accompanied by, how the disease developed. Examines and palpates the breast, evaluates changes in the nipple and breast, detects deformities, determines the presence, size and localization of seals, examines regional lymph nodes.
- Ultrasonography. It has a higher informative value in young patients. Visualizes neoplasms, necrosis zones, changes in the structure of the organ. Allows you to assess the condition of the milky ducts.
- Mammography. Detects tumor nodes, subareolar microcalcinates, fibrosis sites. It makes it possible to determine the thickness of the skin in the area of the nipple and areola. According to indications, it is supplemented by ductography and tomosynthesis.
- Other visualization methods. MRI is used to detect preclinical changes. Scintigraphy is prescribed to confirm the lesion of the ducts in Paget’s cancer, to clarify the size, nature, localization and prevalence of nodes in all forms of oncological lesions.
- Breast biopsy. To take the material, a puncture, a trepan biopsy or a fine needle biopsy are performed. A tissue sample is sent for histological or cytological examination. Similar tests are carried out after receiving a smear print from the nipple of the breast.
- Laboratory tests. They are used to identify cancer markers, determine the level of female sex hormones, and assess the general condition of the body.
The tactics of conservative treatment will be determined by the nature of the pathology. When the nipple is retracted due to individual anatomical features, women are recommended to use vacuum nozzles. During the feeding period of the baby, special pads can be used.
The main method of breast cancer treatment is surgery, conservative techniques are often indicated in the preoperative and postoperative period. In case of metastases to the lymph nodes, radiation therapy is performed. With a high risk of hematogenic and lymphogenic metastasis, cytostatics are used. The progression of hormone-dependent cancer is slowed down by prescribing drugs that reduce the effect of hormones on the gland cells.
With fibrocystic dysplasia, tamoxifen and analogues are used, oral contraceptives are advised to normalize the menstrual cycle. The tuberculosis treatment regimen includes antitubercular therapy, UFO, inductothermy, magnetotherapy, UHF, drug electrophoresis.
Patients with retraction, unrelated to other diseases, undergo plastic surgery to correct the retracted nipples. If a woman plans to have children in the future, a microsurgical operation is performed, during which the connective tissue strands are dissected, and the milky ducts are preserved. If pregnancy is not planned, it is possible to dissect the connective tissue along with the milk ducts.
Zones of fat necrosis, intra-flow papillomas and tuberculous foci are excised by sectoral resection. In case of cancerous tumors , the following operations are performed on the mammary gland:
- radical resection;
- oncoplastic resection;
- subcutaneous mastectomy;
- radical mastectomy;
- mastectomy with radiation;
- mastectomy with prosthetics;
- mastectomy with reconstruction of own tissues.