Breasts: Normal, Medically Worrisome and Things to Be Corrected

By Constance M. Chen, MD, MPH

Breasts come in all shapes and sizes and there is infinite variety in the human experience. Beyond their physiological function of providing nourishment for babies, however, breasts occupy a unique place in the cultural ether and many women wonder and worry about whether or not they deviate from “normal.” “Unfortunately, we are often bombarded by an air-brushed, unrealistic image of what constitutes the normal breast. Even as young women mature and become comfortable with their own unique physical characteristics, there are any number of variations that may trigger questions about what is normal, what is medically worrisome, and what can be ‘corrected’”. 

There is no normal breast size or shape. Nor is there a normal nipple size or color. Nipples and the areolae that surrounds them might be large or small, pale or dark, might match skin tone or might not. Small bumps on the areola are lubricating glands and are completely normal. Chances are that whatever is causing concern is a completely normal variation. Here are some common variations in normal breasts along with recommendations on when to see a doctor.”

Breasts that don’t match: Very few women have perfectly symmetrical breasts. One breast may be larger, shaped differently, or positioned differently than the other. Differences in size up to 20% are normal and are particularly common in teenagers whose breasts may develop at different rates. Hormonal changes associated with ovulation, pregnancy, and breastfeeding that cause changes in breast size may also cause asymmetry. Breasts that differ by more than a cup size and asymmetry unrelated to pregnancy that develop suddenly overnight, however, should be evaluated by a doctor to rule out a medical problem.

Hair on or around the nipples: Human beings have hair all over their bodies. Sometimes human hair is thin and clear and sometimes it’s thicker and darker. It is quite common for women to have darker visible hair around their nipples.” A few hairs is nothing to worry about but denser growth might be indicative of a hormonal imbalance or other issue. The best way to avoid infection when removing hair around the nipples is with small scissors. 

Inverted nipples lie flat against the areola or turn inward instead of protruding. They occur in either one or both breasts and may be present from birth or develop later in life. As many as 10% of women may have one or both nipples inverted. They are not generally a cause for concern and require treatment only if they interfere with breastfeeding, if there is an underlying medical condition that must be addressed, or to satisfy aesthetic preferences. There are several treatment options for inverted nipples, most of them temporary; surgery is the only permanent treatment. Sudden changes, however, may indicate problems that should be evaluated by a physician.

An extra nipple, also called a supernumerary nipple, occurs in 3-5% of people, both men and women, and seldom needs to be removed for any but cosmetic reasons. It may go undetected, mistaken for a mole, and if it occurs alone, it can be removed in a simple procedure much like removing a mole. If it occurs with underlying breast tissue, it should be monitored for changes as the breasts are and removal is much like a mastectomy. 

While these variations are mostly common and benign, there are changes in the breasts that do require examination. While being conscientious about regular mammograms and self-exams checking for lumps, women should also be alert to anything out of the ordinary that persists beyond a menstrual cycle. In particular, there are indications that require medical evaluation.”

• Discharge from the nipples: Fluid can commonly be expressed from the nipples of pre-menopausal women, particularly those who have given birth or nursed a baby in the last year or two, but spontaneous discharge, particularly if bloody or yellow, should prompt a visit to a doctor.
• Skin changes: The skin on the breasts can be affected by common skin conditions like eczema and psoriasis, and from irritation by clothing or other contact, but some skin changes might have a more serious cause. These include ulceration, scaliness, crusting, dimpling, and redness that is not from an identifiable source. 
• Nipple inversion that occurs suddenly in an adult could be a sign of trouble. 

The soft tissue that we think of as a breast is actually a mammary gland, a complex system of fat cells and ducts that produce milk and deliver it to a nursing infant via the nipple. Breasts are remarkable. They fulfill vital functions, undergo changes at different times in a woman’s life, and are as variable as every other part of the human anatomy. Most of these variations are completely normal but any woman with a question shouldn’t hesitate to discuss her concerns with her doctor.

Constance M. Chen, MD, is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. www.constancechenmd.com