Editing Nipple (section)

==Clinical significance==
===Pain===

[[Nipple tenderness|Nipple pain]] can be a disincentive for breastfeeding.<ref>{{cite web|url=https://www.who.int/mediacentre/news/releases/2013/world_breastfeeding_week_20130730/en/|archive-url=https://web.archive.org/web/20130806074415/http://www.who.int/mediacentre/news/releases/2013/world_breastfeeding_week_20130730/en/|url-status=dead|archive-date=August 6, 2013|title=WHO - Breastfeeding: Only 1 in 5 countries fully implement WHO's infant formula Code|website=www.who.int|access-date=12 August 2017}}</ref> Sore nipples that progress to cracked nipples is of concern since many women cease [[Nipple pain in breastfeeding|breastfeeding due to the pain]]. In some instances, an ulcer will form on the nipple.<ref name="Sant2016">{{cite journal|last1=Santos|first1=Kamila Juliana da Silva|last2=Santana|first2=Géssica Silva|last3=Vieira|first3=Tatiana de Oliveira|last4=Santos|first4=Carlos Antônio de Souza Teles|last5=Giugliani|first5=Elsa Regina Justo|last6=Vieira|first6=Graciete Oliveira|title=Prevalence and factors associated with cracked nipples in the first month postpartum|journal=BMC Pregnancy and Childbirth|volume=16|issue=1|pages=209|year=2016|issn=1471-2393|doi=10.1186/s12884-016-0999-4|pmid=27496088|pmc=4975913 |doi-access=free }}</ref> One reason for the development of cracked and sore nipples is the incorrect latching-on of the infant to the nipple. If a nipple appears to be wedge-shaped, white and flattened, this may indicate that the attachment of the infant is not good and there is a potential of developing cracked nipples.<ref name = nhs2>{{cite web|url=http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/sore-cracked-nipples-breastfeeding.aspx|title=Sore or cracked nipples when breastfeeding, Pregnancy and baby guide|publisher=National Health Services (UK)|website=www.nhs.uk|access-date=4 August 2017|date=2017-12-21|archive-date=2017-08-23|archive-url=https://web.archive.org/web/20170823174759/http://www.nhs.uk/conditions/pregnancy-and-baby/pages/sore-cracked-nipples-breastfeeding.aspx|url-status=dead}}</ref> Herpes infection of the nipple is painful.{{sfn|Walker|2011|p=533}} Nipple pain can also be caused by excessive [[friction]] of clothing against the nipple that causes a [[Fissure of the nipple|fissure]].

===Discharge===
Nipple discharge refers to any fluid that seeps out of the nipple of the breast. Discharge from the nipple does not occur in lactating women. And discharge in non-pregnant women or women who are not breastfeeding may not cause concern. Men that have discharge from their nipples are not typical. Discharge from the nipples of men or boys may indicate a problem.  Discharge from the nipples can appear without squeezing or may only be noticeable if the nipples are squeezed. One nipple can have discharge while the other does not. The discharge can be clear, green, bloody, brown or straw-coloured. The consistency can be thick, thin, sticky or watery.<ref name = medline1/><ref>{{cite web|url=http://www.mayoclinic.org/symptoms/nipple-discharge/basics/definition/sym-20050946|title=Nipple discharge|publisher=[[Mayo Clinic]]|access-date=12 August 2017}}</ref>

Some cases of nipple discharge will clear on their own without treatment. Nipple discharge is most often not cancer (benign), but rarely, it can be a sign of breast cancer. It is important to determine what is causing the discharge and to get treatment. Reasons for nipple discharge include:<ref name = medline1>{{cite web|url=https://medlineplus.gov/ency/article/001515.htm|title=Nipple discharge: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|access-date=12 August 2017}}{{PD-notice}}</ref>
* Pregnancy
* Recent breastfeeding
* [[Fissure of the nipple|Rubbing]] on the area from a bra or T-shirt
* Injury to the breast
* [[Mastitis|Infection]]
* Inflammation and [[blocked milk duct|clogging]] of the breast ducts
* Noncancerous [[pituitary tumor]]s
* Small [[breast mass|growth]] in the breast (usually not cancer)
* Severe underactive thyroid gland ([[hypothyroidism]])
* [[Fibrocystic breast changes|Fibrocystic breast]] (normal lumpiness in the breast)
* Use of certain medicines
* Use of certain herbs, such as anise and fennel
* [[Duct ectasia of breast|Widening of the milk ducts]]<ref name = medline1/>

Sometimes, babies can have nipple discharge. This is caused by hormones from the mother before birth. It usually goes away in two weeks. Cancers such as [[Paget's disease of the breast|Paget's disease]] (a rare type of cancer involving the skin of the nipple) can also cause nipple discharge.<ref name = medline1/>

Nipple discharge that is not normal is bloody, comes from only one nipple, or comes out on its own without squeezing or touching the nipple. Nipple discharge is more likely to be normal if it comes out of both nipples or happens when the nipples are squeezed. Squeezing the nipple to check for discharge can make it worse. Leaving the nipple alone may make the discharge stop.<ref name = medline1/>

Nipple discharge in a male is usually of more concern. Most of the time a mammogram and an examination of the fluid is done. A biopsy is often performed. A fine needle aspiration (FNA) biopsy can be fast and least painful. A very thin, hollow needle and slight suction will be used to remove a small sample from under the nipple. Using a local anesthetic to numb the skin may not be necessary since a thin needle is used for the biopsy. Receiving an injection to prevent pain from the biopsy may be more painful than the biopsy itself.<ref>{{cite web|url=https://www.cancer.org/cancer/breast-cancer-in-men/detection-diagnosis-staging/how-diagnosed.html|title=How Is Breast Cancer in Men Diagnosed?|website=www.cancer.org|access-date=12 August 2017}}</ref>

Some men develop a condition known as [[gynecomastia]], in which the breast tissue under the nipple develops and grows. Discharge from the nipple can occur. The nipple may swell in some men possibly due to increased levels of estrogen.<ref>{{Cite journal|last1=Cuhaci|first1=Neslihan|last2=Polat|first2=Sefika Burcak|last3=Evranos|first3=Berna|last4=Ersoy|first4=Reyhan|last5=Cakir|first5=Bekir|date=2014|title=Gynecomastia: Clinical evaluation and management|journal=Indian Journal of Endocrinology and Metabolism|volume=18|issue=2|pages=150–158|doi=10.4103/2230-8210.129104|issn=2230-8210|pmc=3987263|pmid=24741509 |doi-access=free }}</ref>

===Appearance===
[[File:DSC0216 Burma Chin Village near Lemro River Pretty little girl (7374973732).jpg|thumb|Prior to [[puberty]], the nipples on girls are very similar to boys.]]

Changes in appearance may be normal or related to disease.
* [[Inverted nipple]]s – This is normal if the nipples have always been indented inward and can easily point out when touched. If the nipples are pointing in and this is new, this is an unexpected change.
* Skin puckering of the nipple – This can be caused by scar tissue from surgery or an infection. Often, scar tissue forms for no reason. Most of the time this issue does not need treatment. This is an unexpected change. This change can be of concern since puckering or retraction of the nipple can indicate an underlying change in breast tissue that may be cancerous.{{sfn|Hansen|2010|p=83}}
* The nipple is warm to the touch, red or painful – This can be an infection. It is rarely due to breast cancer.
* Scaly, flaking, or itchy nipple – This is most often due to [[dermatitis|eczema]] or a bacterial or fungal infection. This change is not expected. Flaking, scaly, or itchy nipples can be a sign of Paget's disease.
* 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. This is not an expected change.
* Retracted nipples – The nipple was raised above the surface but changes, begins to pull inward, and does not come out when stimulated.<ref>{{cite web|url=https://medlineplus.gov/ency/patientinstructions/000622.htm|title=Breast skin and nipple changes: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|access-date=12 August 2017}} {{PD-notice}}</ref>
The average projection and size of human female nipples is slightly more than {{convert|3/8|in}}.<ref>M. Hussain, L. Rynn, C. Riordan and P. J. Regan, "Nipple-areola reconstruction: outcome assessment"; ''European Journal of Plastic Surgery'', Vol. 26, Num. 7, December, 2003</ref>

===Breast cancer===
Symptoms of [[breast cancer]] can often be seen first by changes of the nipple and areola, although not all women have the same symptoms, and some people do not have any signs or symptoms at all. A person may find out they have breast cancer after a routine [[mammogram]].
Warning signs can include:<ref name = cdcbc/><ref name = cdc2bc>{{cite web|url=https://www.cdc.gov/cancer/dcpc/resources/features/breastcanceryoungwomen/index.htm|title=Breast Cancer in Young Women|access-date=12 August 2017|date=September 8, 2016 |website=CDC |url-status=dead |archive-url=https://web.archive.org/web/20170926020431/https://www.cdc.gov/cancer/dcpc/resources/features/breastcanceryoungwomen/index.htm |archive-date= Sep 26, 2017 }}{{PD-notice}}</ref>
* New lump in the nipple, or breast or armpit
* Thickening or swelling of part of the breast, areola, or nipple
* Irritation or dimpling of breast skin
* Redness or flaky skin in the nipple area or the breast
* Pulling in of the nipple or pain in the nipple area
* Nipple discharge other than breast milk, including blood
* Any change in the size or the shape of the breast or nipple
* Pain in any area of the breast<ref name = cdcbc/><ref name = cdc2bc/>

Changes in the nipple are not necessarily symptoms or signs of breast cancer. Other conditions of the nipple can mimic the signs and symptoms of breast cancer.<ref name = cdcbc>{{cite web|url=https://www.cdc.gov/cancer/breast/young_women/bringyourbrave/breast_cancer_young_women/symptoms.htm|title= Bring Your Brave Campaign - Symptoms of Breast Cancer|website=CDC |access-date=12 August 2017}}{{PD-notice}}</ref>

===Vertical transmission===
Some infections are transmitted through the nipple, especially if irritation or injury to the nipple has occurred. In these circumstances, the nipple itself can become infected with [[Candidiasis|Candida]] that is present in the mouth of the breastfeeding infant. The infant will transmit the infection to the mother. Most of the time, this infection is localized to the area of the nipple. In some cases, the infection can progress to become a full-blown case of [[mastitis]] or breast infection.<ref>{{cite web |url=https://www.who.int/hiv/pub/guidelines/nepal_art.pdf?ua=1 |title=National Anti-retroviral Therapy Guidelines |date=2009 |agency=National Centre for AIDS & STD Control  |website=World Health Organization |format=PDF |access-date=2020-10-05 |archive-date=2020-05-25 |archive-url=https://web.archive.org/web/20200525205408/https://www.who.int/hiv/pub/guidelines/nepal_art.pdf?ua=1 |url-status=dead }}</ref> In some cases, if the mother has an infection with no nipple cracks or ulcerations, it is still safe to breastfeed the infant.

[[Herpes infection]] of the nipple can go unnoticed because the lesions are small but usually are quite painful. Herpes in the newborn is a serious and sometimes fatal infection.{{sfn|Walker|2011|p=533}} Transmission of Hepatitis C and B to the infant can occur if the nipples are cracked.<ref>{{cite web|url=https://medlineplus.gov/ency/patientinstructions/000803.htm|title=Breastfeeding vs. Formula Feeding |website=MedlinePlus Medical Encyclopedia |access-date=12 August 2017}}</ref>

Other infections can be transmitted through a break of the skin of the nipple and can infect the infant.

===Other disorders===
{{div col|colwidth=30em}}
* [[Nipple bleb]]
* [[Candida infection]] of the nipple
* Eczema of the nipple
* [[Inverted nipple]]
* [[Staphylococcus]] infection of the nipple
* [[Edematous areola]]{{sfn|Walker|2011|p=524}}
* [[Herpes infection]] of the nipple
* [[Reynaud phenomenon of the nipple]]{{sfn|Walker|2011|p=533}}
* [[Flat nipple]]{{sfn|Walker|2011|p=530}}
{{div col end}}

===Surgery===
A [[Nipple delay|nipple-sparing/subcutaneous mastectomy]] is a surgical procedure where breast tissue is removed, but the nipple and areola are preserved. This procedure was historically done only prophylactically or with mastectomy for the benign disease over the fear of increased cancer development in retained areolar ductal tissue. Recent series suggest that it may be an oncologically sound procedure for tumours not in the subareolar position.<ref name="pmid12832974">{{cite journal  |vauthors=Gerber B, Krause A, Reimer T, etal |title=Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure |journal=Ann. Surg. |volume=238 |issue=1 |pages=120–7 |year=2003 |pmid=12832974 |doi= 10.1097/01.SLA.0000077922.38307.cd|pmc=1422651}}</ref><ref name="pmid17269590">{{cite journal |vauthors=Mokbel R, Mokbel K |title=Is it safe to preserve the nipple areola complex during skin-sparing mastectomy for breast cancer? |journal=Int J Fertil Female's Med |volume=51 |issue=5 |pages=230–2 |year=2006 |pmid=17269590 }}</ref><ref name="pmid17084333">{{cite journal  |vauthors=Sacchini V, Pinotti JA, Barros AC, etal |title=Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? |journal=J. Am. Coll. Surg. |volume=203 |issue=5 |pages=704–14 |year=2006 |pmid=17084333 |doi=10.1016/j.jamcollsurg.2006.07.015 }}</ref>