Hello Readers,
The election fever has ended, and I hope all of you have done your duty by casting your vote. In our previous newsletters, we have discussed in detail the structure of the breast, common benign conditions, and the importance of early detection of breast cancer. An equally important yet often overlooked aspect of breast health is the nipple.
Many women notice changes in the nipple at some point in their lives, but may feel unsure or hesitant to talk about them. These changes can range from completely harmless conditions to signs that require medical attention. Understanding what is normal and what is not can help reduce unnecessary anxiety while ensuring timely care when needed.
The nipple and the surrounding darker area, called the areola, are composed of skin, ducts, and specialised glands. They are influenced by hormonal changes and are also prone to common skin conditions, just like any other part of the body.
One of the most frequently encountered concerns is itching, dryness, or flaking of the nipple. This is often due to simple skin conditions such as eczema or irritation caused by soaps, tight clothing, or sweating. In such cases, both nipples are usually affected, and the symptoms can be on and off. Keeping the area clean and well-moisturised, and avoiding irritants often helps.
However, if there is persistent itching or rash involving only one nipple, especially if it is associated with crusting, scaling, redness, or ulceration that does not improve with basic care, it is important to seek medical evaluation. Though uncommon, certain early cancer-related conditions, such as Paget’s disease, can affect the nipple and resemble eczema.
Another common concern faced by many women is nipple discharge. It is important to understand that not all nipple discharge is abnormal. Some women may notice a milky or clear discharge, which can be a normal physiological response to hormonal fluctuations, certain medications, or even stress. It is considered less concerning when it occurs from both breasts and only on squeezing.
Greenish nipple discharge is fairly common and occurs when the milk ducts beneath the nipple become widened (dilated) and accumulate thick secretions over time. These secretions can appear green, yellow, brown, or even black in colour. It is more commonly seen in women in their late 30s and beyond, particularly around the perimenopausal period, when hormonal influences on the breast begin to change.
However, certain types of discharge should not be ignored. Specifically, spontaneous or persistent bloody discharge (occurring without squeezing), especially from a single breast, requires further medical evaluation to rule out any underlying cancer.
Changes in the shape or position of the nipple are also important to understand. Some women naturally have inverted nipples from a young age, and this is usually a normal anatomical variation. These nipples may appear pulled inward, but can often be brought out with gentle stimulation.
In contrast, if a nipple that was previously normal becomes newly inverted or pulled inward, it should be evaluated. This type of change, especially when affecting only one side, may indicate an underlying breast condition and requires prompt medical attention.
It is also important to look for other associated changes, such as a lump in the breast, skin dimpling, redness, or thickening around the nipple area. These features, particularly when present on one side, should not be ignored.
As with the rest of breast health, a key point to remember is the difference between changes affecting both breasts and those affecting only one. Bilateral changes are often related to hormonal or benign conditions, while unilateral, persistent changes are more concerning and warrant further evaluation.
The purpose of awareness is not to create fear, but to help women feel informed and confident about their bodies. Most nipple-related concerns are benign and easily manageable. However, recognising when something is unusual ensures that care is sought at the right time.
Dr Swathika Rajendran
Junior Consultant – Breast Surgery,
Kauvery Hospital, Chennai
