Imagine looking in the mirror one day and noticing that your nipple had suddenly flattened or turned inwards. It may gradually return to normal or stay retracted. Even so, it is usually caused by benign conditions such as menopause. However, it could also be a sign of breast cancer, especially if it comes with other changes to the breast. If you want to figure out what’s wrong, breast cancer screening is your best bet. It is crucial to identify early signs of cancer and treat it before it spreads, improving the chances of successful treatment. Read on to find out more about nipple retraction and how it relates to breast cancer.
What is Nipple Retraction?
Nipple retraction is a condition where the nipple lays flat or turns inwards instead of protruding out. It happens to around 10% of the population (men and women), most of which are congenital and harmless.
Inverted nipples are categorised into 3 grades:
- Grade 1: Nipple retraction can be resolved easily by pulling the nipple out. Breastfeeding is still possible.
- Grade 2: Nipple can be pulled out, but eventually retracts back in.
- Grade 3: The nipple cannot be pulled out at all, and breastfeeding is nearly impossible.
Some people develop nipple retraction suddenly, causing concern. However, this can be from temporary or benign changes including:
- Natural ageing: As one near menopause, the milk ducts shorten and the breasts lose structure, leading to nipple retraction.
- Trauma: Surgery or injuries to the breast form scar tissues, which have less elasticity than normal tissues. Tight tissues can pull the nipple inwards, creating nipple retraction.
- Breastfeeding: Frequent latching and sucking places stress on the nipple tissues, which eventually causes structural changes like nipple retraction. The risk is higher if the baby is not latching properly.
- Weight loss: Loss of fat tissues behind the nipple causes flattening or retraction of the nipples
Beyond these causes, nipple retraction can also be indicative of underlying medical conditions like a benign tumour or breast cancer. More diagnostic tests are required.
Is Nipple Retraction a Sign of Breast Cancer?
Nipple retraction can be a sign of breast cancer, especially when it only affects one nipple and is accompanied by other symptoms lumps, skin changes, and nipple discharge.
Common types of breast cancer associated with nipple retraction include:
- Ductal carcinoma: Cancerous growths can pull on breast tissues beneath the nipple, pulling the nipple inwards.
- Inflammatory breast cancer: Rare and advanced form of breast cancer mainly characterised by edema (swelling) and redness. Changes in nipple appearance, including flattening, retraction, crusting, or blisters are commonly observed as well.
- Paget’s disease of the breast: Rare form of breast cancer that originates on the outer layer of the nipple, eventually spreading to the nearby skin cells, also known as areola. The main changes are on the nipple, including redness, crusting, discharge, and inversion.
Without further diagnostic tests, it is difficult to identify the cause of nipple retraction. If you observe sudden changes to the nipple and breasts or experience pain near the areola, seek medical attention immediately.
Other Symptoms to Watch For Alongside Nipple Retraction
Nipple retraction can be a sign of concern when it comes with other symptoms including:
- Breast lumps
- Nipple discharge (bloody or yellowish)
- Skin changes e.g. dimpling, redness, crusting, or thickening
- Breast pain or swelling
Breast Cancer Screening: When to Get Screened
Breast cancer screening is a universal test that all women should get, regardless of whether one experiences any abnormalities.
For its simplicity, breast screening does wonders in detecting early signs of breast cancer, including lumps or nipple changes. There are various types of screening methods to cater to each woman’s needs:
Mammograms
Mammography is the most common screening test for breast cancer. It uses low doses of X-rays to create images of the breast tissues, helping physicians detect lumps, masses, or other abnormalities suggestive of benign or cancerous tumours.
Ultrasound
An ultrasound is a scan that uses sound waves to produce images. Without using radiation, this is a relatively safe process and a good alternative for pregnant women. Ultrasounds are often used together with mammograms to further evaluate the nipple regions, which may not be well-visualised in mammograms due to their density. They can also distinguish between fluid-filled cysts and solid masses.
MRI
Magnetic resonance imaging (MRI) uses large radio waves to produce detailed images of breast tissues. While they are more sensitive to early-stage cancers, the process is more complicated and riskier than other imaging tools. MRI is often recommended if other imaging tests are inconclusive or when the patient has a high risk of breast cancer.
The risk of developing breast cancer increases with age. While we cannot combat against time, regular screening is crucial in catching early signs so that we can receive treatment before the cancer develops. Hence, it is recommended that women aged 40 and above schedule a screening at least once a year.
But self-awareness is not just a yearly affair. Regular self-examinations should be performed at least once a month, a few days after your menstrual period. You can perform self-examination either during your shower, in front of a mirror, or lying down. Observe your breasts for any visual changes in shape and size. Look for any redness, dimpling, or puckering on the skin as well as the nipples. Next, use the pads of your fingers to feel for lumps or any thickening of the breasts. Apply varying pressure that is comfortable for you. Be sure to check the entire breast, from the collarbone to the top of your abdomen and from the armpit to the centre of your chest.
Though self-examinations are not a replacement for mammograms, they are a proactive way for women to monitor their breast health and be more familiar with their bodies.
What Happens During a Breast Cancer Screening?
Book an appointment when your breasts are less tender, preferably a week after your menstrual period. Avoid wearing any jewellery, deodorant, lotion or powders on the underarms as they might affect the accuracy of the images.
Before the screening, be prepared to provide information or documents about your medical history, current medications, and family history of breast cancer. Thereafter, will you be asked to change into a gown. You will stand in front of an X-ray machine, and two compression plates will be placed on either side of the breast to spread out the breast tissues. The physician will capture the X-ray images and reposition the breasts to get different angles. While you may feel some discomfort from the compression of the plates, it is generally painless. The whole process lasts about 20 to 30 minutes.
If abnormalities are found, a biopsy will be performed to extract a small sample of breast tissues for lab examinations.
Non-Cancer Causes of Nipple Retraction
Nipple retraction can be from non-cancerous medical conditions including:
- Infection: Known as mastitis, inflammation of the breast tissues will pull the nipples inwards.
- Mammary duct ectasia: Thickening or dilation of the milk ducts, common in older or breastfeeding women. This creates extra pressure on the tissues, altering the nipple structure. This can form clogged milk ducts or inflammation, forming more pressure.
The symptoms can be very similar to breast cancer, hence it is important to consult a healthcare professional to get an exact diagnosis.
Treatment Options for Breast Cancer Detected from Nipple Retraction
If breast cancer is diagnosed, various types of therapy will be used in combination based on the type, stage, and characteristic of the cancer:
Radiation Therapy
This involves high-energy waves to target and destroy cancer cells. Depending on the size and location of the tumour, radiation therapy can vary in its dose, duration, and area applied. They are commonly used after surgery to destroy any remaining cancer cells to minimise the chances of cancer recurrence. However, radiation can also destroy healthy cells, causing side effects like nausea, fatigue, hair loss, etc.
Chemotherapy
Chemotherapy is the use of drugs to kill or slow down cancer growth. They come in the form of tablets, injections, or topical creams. They can be used before or after surgery, or as the primary form of treatment. The duration, dosage, and drug combination are often tailored based on the patient’s response to the treatment.
Hormonal Therapy
Effective for hormone receptor-positive breast cancer, drugs like Tamoxifen blocks reproductive hormones (estrogen and progesterone) from binding to the receptors on cancer cells.
Targeted therapy
This is a new field in cancer treatment aimed to minimise side effects by targeting specific characteristics of cancer cells like a receptor or protein. Advanced technology can engineer our immune cells or create new synthetic drugs to identify and target cancer cells specifically through their biomarkers.
Surgery
Breast cancer surgery involves the removal of cancerous tissue from the breast. There are several types of surgeries including:
- Lumpectomy: Removes the tumour and a small margin of surrounding tissue.
- Mastectomy: One or both breasts are removed partially or entirely. This is performed when the cancer is more advanced and has spread to a large margin of the breasts.
The choice of surgery depends on the cancer’s stage, size, location, as well as the patient’s overall health and personal preferences. The priority is to preserve the breast while eliminating as many cancer cells as possible.
Preventing and Reducing Breast Cancer Risk
Prevention is better than cure. We have the responsibility to take charge of our health to minimise the risk of breast cancer, including:
- Healthy diet: Moderate your alcohol intake, avoid smoking, and incorporate healthy fibres like fruits and vegetables into your daily meals.
- Exercise: Aim for at least 150 minutes of moderate to vigorous exercise per week.
More importantly, early detection of changes in the breast could accelerate getting an accurate diagnosis and treatment. If you have a family history of breast cancer, genetic screening would be a good option to identify whether you carry genetic mutations related to breast cancer.
When to See a Doctor About Nipple Retraction
Nipple retraction with other symptoms like bloody or yellowish nipple discharge, skin changes, breast lumps or pain require immediate medical attention.
Even if you have no symptoms, a yearly breast screening helps to detect potential abnormalities within the breast tissues that cannot be observed.
Conclusion
Nipple retraction, an inward pulling of the nipple, can be a potential sign of breast cancer and should never be ignored. While it can occur due to benign conditions, persistent nipple changes like retraction or discharge could indicate underlying issues such as breast cancer or other malignancies. Regular breast cancer screening and self-examinations are crucial in catching early signs of cancer when it is most treatable. If you notice any breast changes—whether it be nipple retraction, lumps, discharge, or skin alterations— consult a doctor promptly.
Safeguard Your Health Today
At Centre for Screening and Surgery, we prioritise delivering quality and comfortable early cancer screening and treatment using minimally invasive procedures. If you notice any abnormalities in the breasts and want a breast screening, call us to book an appointment today!
