Breast Health 101: What is Normal and What is a Concern?

Understanding breast abnormalities and overall breast health can help ease anxiety. Whitney Cowman, MD, and Therese Michels, Breast and Bone Health Manager with UnityPoint Health, explain which breast changes are normal, what may be cause for concern and when to get checked.

Why Do I Have Bumps On My Nipples?

The areola contains numerous lubricating glands, called Montgomery glands (also called areolar glands). These show up as bumps on the areola and are completely normal.

When to Worry

Much like moles, it’s best to seek advice from your provider about any changes in the following:

• Affects one breast but not the other
• Color
• Discharge that’s bloody or yellow
• Shape
• Skin texture that becomes flaky or red
• Size

Is Nipple Discharge Normal?

Discharge from the nipple can be expressed from the nipple ducts in the following situations:

• Nearly 75% of women who have lactated within the past two years
• Nearly 40% of premenopausal women
• 55% of women who've given birth

The discharge generally comes from more than one duct. Fluid caused by manual expression that appears in these colors is usually considered normal:

• Brown nipple discharge
• Clear nipple discharge
• Green nipple discharge

When is Nipple Discharge a Concern?

Spontaneous nipple discharge should be evaluated by your provider. This can be caused by medications, chronic breast stimulation, thyroid disease or other chronic medical conditions. Bloody nipple discharge, or straw-colored (serous) fluid, especially from a single duct, needs attention.

From benign to more concerning conditions, nipple discharge can be a sign of mastitis, a benign infection you can get at any age. Symptoms of mastitis can also include breast swelling, skin redness, pain or burning, breast tenderness and generally feeling unwell. Nipple discharge can also be an early sign of breast cancer.

Why Are My Nipples Itchy?

While itchy nipples are sometimes associated with breast cancer, they're more often caused by everyday skin irritation, hormonal changes or other benign conditions, including:

• Allergic reactions or contact dermatitis
• Changes in laundry detergent, soap or skincare products
• Dry skin
• Eczema or other skin conditions
• Hormonal changes related to pregnancy, breastfeeding, menopause or menstruation
• Irritation from a bra or clothing
• Thrush, especially if you’re breastfeeding

If you experience itchy nipples and suspect it’s from a mild skin irritation, consider using an over-the-counter antibiotic cream.

When are Itchy Nipples a Concern?

Itchy nipples can be concerning when they’re accompanied by persistent discomfort, unusual changes in the breast skin or other symptoms that may indicate an underlying medical condition. Itchy nipples can also be a sign of the early onset of breast cancer, such as Paget’s disease, which is a type of breast cancer that can look like skin irritation, such as eczema.

Hair on Nipples

Just like other skin surfaces on the body, the areola (dark circle around the nipple) contains hair follicles, so hair on the breast is considered normal. Shaving or plucking could lead to infection. If the hair bothers you, it’s best to cut it with small scissors.

When is Hair on Nipples a Concern?

Hair on the nipples is rarely concerning. However, if you notice a sudden increase in nipple hair growth and/or new symptoms accompany nipple hair changes, contact your doctor.

What Causes Inverted Nipples?

An inverted nipple happens when a nipple retracts into the areola. Approximately 10-20% of women have inverted nipples on at least one breast. So, if you’ve always had one or two inverted nipples, this is normal for you and not a concern. They can, however, create challenges for women who’d like to breastfeed.

When are Inverted Nipples a Concern?

If having an inverted nipple is different from your normal, or is more pronounced than what’s typical for you, talk to your provider. An inverted nipple can also be a sign of breast cancer.

Why Are My Areolas so Big?

Areolas come in all different sizes and colors, mostly due to hereditary factors. Some women notice dark areolas, or an increase in size with pregnancy and breastfeeding, but these features usually return to their pre-pregnancy appearance after you're done breastfeeding.

When are Big Areolas a Concern?

Call your provider about any type of change to your areola. It’s best to be safe and have peace of mind while continuing to monitor the area for any further changes.

Why Do My Nipples Hurt?

Nipple pain is common and is usually related to hormonal fluctuations, skin irritation or breastfeeding. Additional causes include:

• Eczema or allergic reactions
• Mastitis or other infections
• Menstrual cycle changes
• Pregnancy

Nipple pain is also caused by a nipple fissure, a small crack in the skin that often develops during breastfeeding or from repeated friction, such as from a bra, running or other high-impact exercise.

When is Nipple Pain a Concern?

Since any change in your breast could potentially be resolved with a simple treatment, or be a sign of breast cancer, contact your provider if you’re experiencing nipple pain or soreness.

Breast Skin Changes and Stretch Marks

The breast can be affected by common skin problems, including itchy, dry patches from psoriasis or eczema. It’s also possible to get a rash from anything that comes into contact with breast skin (contact dermatitis), like clothing. Stretch marks are normal, too, and can appear as red, spoke-like lines on the skin during times of rapid physical growth, such as puberty or pregnancy. Over time, stretch marks often fade.

When are Skin Changes in the Breast a Concern?

Some skin changes are not normal, including:

• Crusting
• Dimpling
• Redness
• Scaling
• Skin retraction
• Swelling (edema)
• Ulcerations

Palpable breast masses (masses you can feel) should be evaluated by a provider. Most breast masses are benign and not cancerous, but it’s important to see your doctor for an exam and discuss family history.

Can Breast Shape or Size Change?

Heredity is the most important factor in determining how big breasts will be. No creams, special exercises or clothing will permanently change your breast size. Breast size may fluctuate with weight loss or weight gain or during/after a pregnancy, but for the most part, your breasts stay the same size after puberty.

It's also common to have uneven breasts. Because of different breast sizes, women may find that during lactation, one breast may produce more milk than the other, causing one to be larger.

“It’s normal to feel self-conscious about the way our breasts look or feel, but we’re all unique and special,” Dr. Cowman says. “As women’s healthcare providers, we’re happy to discuss any of your concerns. Sometimes, just hearing things are normal can be very reassuring.”

When to See a Doctor About Breast Changes

“You know your body best. Follow your instincts and advocate for yourself. Remember, the earlier you act upon any breast changes, the better the outcome. It’s always best to treat breast symptoms as early as possible," Michels says.