Nipple nubbins, skin tags, and other abnormalities

Why does my nipple look different?

Nipple size generally does not affect breastfeeding, but certain nipple shapes and abnormalities can increase the risk of pain, damage, and latching problems. A nubbin is a part of the nipple that sticks out from the nipple face. A baby can cause pain and damage by pulling on it more than the rest of the nipple, but generally the nipple adjusts and the pain and damage stop. A skin tag, a little bit of extra skin that can form on the nipple or areola is generally not a problem for breastfeeding. There are range of other abnormalities that appear infrequently but may cause breastfeeding problems or require medical attention.

A) Describing nipple abnormalities

Nipples come in different sizes and shapes. Size does not usually affect breastfeeding unless the baby is very small and the nipple very large. Certain shapes and abnormalities increase the risk of nipple pain, nipple damage, or latching problems. The risk depends on the type and location of the abnormality.

B) Nubbins

A medium sized nubbin. This did not cause any breastfeeding problems.

A nubbin is a part of the nipple that sticks out farther than the rest of the nipple face. Nubbins can be small or large. A baby may pull more on the nubbin than on the rest of the nipple, causing pain and damage, typically where the nubbin meets the rest of the nipple. This is shown in the pictures at the bottom of this FAQ. 

Generally, nipples, even those with nubbins, adjust to breastfeeding and the pain and damage settle.

A large nubbin may cause a baby to have difficulty latching. This may be temporary or permanent.

C) Skin tags

Skin tags are little bits of extra skin on a narrow stalk. These are generally less than 2 mm (3/16 of an inch) thick.

They can appear on the breast, areola, or nipple and usually cause no problems.

Occasionally a tag can get tender from being pulled around in the baby’s mouth. In rare cases, the blood supply to the tag is disrupted and the tag turns dark and falls off. This process can be painful and may take a few days. Once they fall off, there is no more pain.

Skin tags usually don’t require treatment, but if you have one that causes ongoing pain with breastfeeding, you can see your health-care providers to discuss having it removed.

Warts can also appear as skin tags or growths on the nipple.

D) Other abnormalities of the nipple

An adenoma (syringomatous) of the nipple.

Nipples may be indented in the middle (dimpled), which may be a sign of an inverted nipple. Dimpled nipples are also more likely to become painful and damaged.

Other nipple abnormalities include:

  • A nipple that is partly or completely split into two parts (bifid nipple)
  • Affected by various genetic conditions
  • A non-cancerous (benign) tumour (adenoma) (Spohn 2016) (These may be a sign of an under-lying breast cancer.)
  • A benign fluid-filled lump (inclusion or sebaceous cyst)
  • A cutaneous horn (a bump or horn of nail-like material)
  • Breast cancer
  • Skin cancer (Nagata 2018)

The impact of a nipple abnormality on breastfeeding depends on the nature of the abnormality. Please see your health-care providers if your nipple:

  • Looks different.
  • Bleeds. 
  • Is painful.
  • Is suddenly always hard. 
  • Is causing you concerns.

References

Nagata Y, Yoshioka M, Uramoto H,et al. Malignant Melanoma of the Nipple: A Case Report. J Breast Cancer. 2018 Mar;21(1):96-101
 
Spohn GP, Trotter SC, Tozbikian G, et al. Nipple adenoma in a female patient presenting with persistent erythema of the right nipple skin: case report, review of the literature, clinical implications, and relevancy to health care providers who evaluate and treat patients with dermatologic conditions of the breast skin. BMC Dermatol. 2016 May 20;16(1):4