There are many body worries you might confess to your friends, from weight to bra size.
But there’s one part of their anatomy that women rarely discuss: nipples.
We might glimpse another woman’s breasts on a topless beach or in the gym changing room, or see a pair of impossibly perfect and pert ones on screen but, mostly, the only ones we see in any detail are our own, causing us to wonder if they’re – well – normal.
The truth, according to Oxfordshire-based consultant plastic surgeon Niki Petrie, who is a specialist in breast reconstruction, is that ‘normal’ encompasses a very broad spectrum of colour, size, position, protrusion, symmetry and sensitivity.
And she warns that nipples will continually change with age, weight and hormone fluctuations and are often irreversibly impacted by pregnancy and breastfeeding.
So, if you’ve ever wondered whether your nipples are normal, read on to hear what the experts have to say…
Consultant plastic surgeon Niki Petrie, who is a specialist in breast reconstruction, says nipples will continually change with age, weight and hormone fluctuations
Colour
The colour of your nipples is largely determined by genetics. The skin is generally darker if you have dark skin, and paler if you are fair, but Petrie says there is huge variation in people of the same race.
She explains that ‘nipple’ is actually the correct term for the small central projecting part where (in women) the milk ducts exit the body. The larger pigmented flat area that surrounds the nipple is called the areola. Together this forms the ‘nipple areola complex’ or NAC.
‘Oestrogen levels in the blood can impact the colour of the areola, so the skin may get darker at puberty, during pregnancy, when taking oral contraceptives and during breastfeeding,’ she says, ‘but it can become very pale after menopause as oestrogen levels naturally drop.’
Areola skin also has little bumps called Montgomery’s glands, which release an oily secretion that helps lubricate the nipple for breast feeding. These bumps can become more prominent during breast feeding and remain prominent afterwards.
Size
The nipple itself is usually around 10-12mm wide and 9-10mm high, while the average size of a nipple complex is 3-6cm in diameter. However, if the skin is stretched by the weight of large breasts an areola can be as large as 10 or 12 cm across.
And don’t worry if your nipples are hairy, as long hairs often grow out of the outer rim of the areola.
Position
On a young breast, the nipple complex will usually sit higher on the breast with the nipple pointing slightly upwards. However, according to Petrie, the nipple will normally drop with age, with the degree of drop depending on your skin elasticity, breast size, number of pregnancies and other factors such a weight loss, smoking and genetics.
If you have small breasts and very elastic skin, your nipples may remain in the optimal position. However the weight of larger breasts, or breasts that expand during pregnancy and breastfeeding, can stretch the delicate skin, causing the nipple to drop.
‘The force of gravity is dependent on the mass, so the heavier your breasts, the more gravity will have its effect, bringing the nipple down,’ explains Petrie.
The degree of sagging is called ‘ptosis’ and is graded according to nipple position, graded from 1 (mild ptosis) to 3 (severe ptosis) where the nipple sits at the bottom of the breast, pointing downwards.
Protusion and inversion
The nipple houses 15 to 20 milk ducts along with muscle fibres that constrict to push it out. However, according to Miles Berry, a London-based consultant cosmetic surgeon, around 15 per cent of the population are born with one or both nipples pointing inwards or lying flat.
‘The most common scenario is a ‘shy’ nipple that will sometimes stand out on its own with cold or stimulation,’ he explains. ‘But some people have one or both nipples which can either be pulled out but swiftly shrink back, or which remain stubbornly inverted.’
Inverted nipples can be surgically corrected under a local anaesthetic but Berry warns that, even when surgically corrected, inverted nipples are rarely conducive to successful breastfeeding. Sometimes small suction devices can be used to encourage the nipple to turn out for just long enough for the baby to latch on.
Sensitivity
When the nipple complex is stimulated by touch, cold or sexual arousal, tiny muscle fibres contract, causing the skin to shrink and wrinkle the nipple to become erect.
This impulse is driven by the autonomic nervous system, which is part of the ‘fight or flight’ impulse over which we have no control and that will vary in response and intensity from one person to another.
The link between nipples and sexual arousal is a very individual one too. ‘Some women tell me if it wasn’t for their breasts they wouldn’t be able to orgasm,’ says Petrie. ‘Yet others say they get very little sexual pleasure from stimulation.
‘Anecdotally, it seems women with large breasts notice less sensation in the nipples and this could happen if the skin of the nipple complex is stretched beyond the capacity of the nerves that run through it.’
Studies have shown that larger breasts are significantly less sensitive than smaller ones, which could be caused by the increased gravitational force on the sensory nerves.
Symmetry
Ignore the pert, ‘perfect’ breasts you see on TV because, according to Petrie, ‘asymmetry in the breasts is so common it is almost the norm’.
She says half of women have a volume difference in their breasts of 10 per cent or more, and a quarter of women will have a volume difference of 20 per cent or more.
‘If one of your breasts is bigger than the other, your nipples will probably sit in different positions,’ she says. ‘So don’t be alarmed if one nipple complex seems bigger or lower than the other.’
Sensation and sensitivity can be very different on each side of the body too, so one nipple may contract in the cold faster than the other.
Extra or missing nipple
One to two per cent of the population have one or a few ‘false’ nipples sitting on the ‘breast meridian’ or the ‘milk line’ which runs down in a sweeping arc from the collar bone towards the groin.
This is called ‘polythelia’ and Petrie says the extra nipples are often mistaken for moles. These can be left if asymptomatic, but very rarely people might get breast tissue behind the extra nipple which might require a referral to a specialist.
The complete absence of a nipple complex is called ‘athelia’, which is very rare.
Nipple reconstruction can be performed surgically by wrapping skin around itself to form a 3D projection, or a surgeon can perform a ‘nipple share’ procedure taking part of the nipple from the other breast, Petrie explains.
Additionally, 3D tattoo procedures can create a realistic-looking nipple.
Worrying signs
Watch out for any unexpected changes to your nipples, such as:
- One nipple starts to look as if it is being pulled inwards
- You notice unfamiliar flakiness or redness in the nipple area (nipple eczema is not uncommon if you have eczema elsewhere, but new eczema should be checked)
- Any discharge
- A lump under the nipple
- Any ongoing pain or discomfort
- Any of these could be signs of cancer, including a rare form of breast cancer called Paget’s disease of the nipple. About 1 to 4 per cent of women with breast cancer have Paget’s disease of the nipple.
Nipple care
Look after your skin by keeping it well moisturised.
‘Increased hydration may help retain the skin’s elasticity and therefore minimise the effect of gravity,’ says Petrie. ‘It is also beneficial to eat a well-balanced diet, avoid smoking, take regular exercise and maintain a stable weight,’ she adds.
‘Wear a well-fitted and supportive bra, especially when exercising, as this will minimise breast movement which can contribute to sagging and drooping nipples.
‘Ensure you examine your breasts – and your nipples – regularly and report any changes to your GP.’
