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

Understanding the difference between a normal breast and breast abnormalities can help ease anxiety around overall breast health. Whitney Cowman, MD, UnityPoint Health and Therese Michels, Breast and Bone Health Manager, UnityPoint Health, explain several features of breasts that might seem odd but are normal and signs that may indicate something is off and worth getting checked out.

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 nipple 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.

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 with inverted nipples.

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 be a sign of breast cancer.

Nipple Discharge

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

• Nearly 40% of pre-menopausal women
• 55% of women who’ve had a baby
• Nearly 75% of women who’ve lactated in the last two years

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

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

When is Nipple Discharge a Concern?

Spontaneous nipple discharge should be evaluated by your provider. This can be caused by medication, 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.

Bumps on Nipple

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

When are Bumps on the Nipple a Concern?

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

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

Itchy Nipple

Itchy nipples can be caused by a variety of things, including:

• Dry skin
• Irritation from a bra
• Change in laundry detergent
• Pregnancy or menopause hormonal changes
• Thrush, especially if you’re breastfeeding

If you’re experiencing itchy nipples and suspect it’s from a mild skin irritation, consider using an over-the-counter antibiotic cream. If symptoms persist, contact your doctor.

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.

Big Areolas

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 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.

Nipple Pain

Nipple pain causes can stem from any of the following:

• Menstrual cycle
• Pregnancy
• Skin irritation or infection
• Hormonal changes
• Mastitis
• Breastfeeding

Nipple pain can also result from a nipple fissure, which is caused by breastfeeding or continuous friction from clothing on the nipple, like when jogging or during excessive 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 also normal and can look like red spoke-like lines, which appear 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:

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

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.

Breast Shapes and Sizes

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/gain or during/after a pregnancy, but for the most part, your breasts stay the same size after puberty.

It’s not unusual to have uneven breasts either. 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.”

Michels adds, “You know your body best. Follow your instinct 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.”