Nipple retraction or a change in nipple shape can be present from birth or develop later. There are many possible causes; most are benign, but some findings require further evaluation. Below is general information on how this symptom can present, likely causes, typical evaluation steps and when to seek urgent care.
Retraction may affect one or both nipples and can appear suddenly or be long-standing and stable. Descriptions include inversion, dimpling, asymmetry or a pulled-in appearance. Skin changes such as crusting, redness, discharge or local pain can accompany retraction. Distinguishing a lifelong inverted nipple from a new change is important for assessment.
Causes range from benign to more serious. Benign reasons include congenital inverted nipples, fibrocystic changes, scar tissue, prior trauma or changes related to breastfeeding. Infectious processes such as mastitis can also cause localized retraction. Less commonly, underlying malignancies or conditions like Paget disease of the nipple may be associated with shape change. Clinical evaluation determines the need for further testing.
Initial assessment usually begins with a clinical exam and medical history, focusing on timing of the change and any accompanying symptoms (discharge, lump, skin changes). When indicated, imaging such as ultrasound, mammography or MRI and, in some cases, a tissue sample (biopsy) help clarify the cause. Which tests are appropriate is determined by the clinician based on the exam.
Prompt medical attention is recommended if retraction is accompanied by severe or rapidly worsening pain, fever, intense redness or swelling, bloody nipple discharge, skin breakdown or a quickly enlarging lump. These signs may need urgent evaluation at a healthcare facility. For non-urgent concerns, start with a primary care clinician who can arrange specialist referral if needed.
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