Are Pale Nipples a Cause for Concern?

Just as breasts come in all shapes and sizes, nipples can vary greatly from person to person, too.

Nipple color is usually related to your skin color, but changes in hormone levels and other factors can cause the color of your nipples and areolae (the darker circle of skin around your nipple) to change at certain times.

Pale nipples are usually not a sign of a serious problem. However, it’s important to pay close attention to any changes to your breasts or nipples. Sometimes visible changes are the first sign of a condition that needs medical attention.

What causes pale nipples?

Through the years your breasts may change in size and shape. Skin texture may change, too. And changes in nipple color can happen throughout your life for various reasons.

• Pregnancy. During pregnancy your nipples and areolae may become darker and larger, and then return to their normal color later on.
• Breastfeeding. Women who breastfeed sometimes find their nipples become faded in color.
• Menopause. After menopause, your nipple area may become smaller and paler. This is perfectly normal and one of the many common changes that can affect your breasts over time.
• Changing hormone levels. Your hormones can have a lot to do with the darkening or lightening of your nipples and areolae. If you take oral contraceptives, one possible side effect is pale nipples.
• Breast augmentation surgery. This type of surgery may change the appearance of your nipples, possibly making them paler than they were before the procedure.
• Lumpectomy. If you’ve had a lumpectomy — a common treatment for some types of breast cancer — the nipple area of the affected breast may become paler over time.

You may notice that one nipple is somewhat paler than the other. Keep in mind, though, that if you don’t have any other signs or symptoms, a lightening of skin color around one or both nipples is usually a harmless change.

What are the treatment options?

If there is no underlying medical condition, no treatment is necessary for pale nipples.

If, however, you wish to darken the skin around your nipples, you can opt for areola tattooing. This procedure is often done as part of breast reconstruction following a mastectomy to recreate an areola to help the breast look “whole” again.

Areola tattooing may also be done to darken the nipple area that has become pale due to breastfeeding or hormonal changes.

If this type of tattooing is of interest to you, talk with a dermatologist or a specialist in breast reconstruction.

What types of nipple changes are not normal?

While pale nipples alone are typically not a cause for concern, there are some nipple changes that could be a sign of a more serious condition.

Nipple discharge

If you’re not breastfeeding, any nipple discharge or fluid leaking from one or both nipples should be discussed with your doctor. It may be nothing serious, especially during your reproductive years, but it is best to get it checked out.

Inverted nipples

About 10 percent of women have at least one inverted nipple (a nipple that turns inward rather than outward). An inverted nipple may be permanent or it may change in response to stimulation or a change in temperature.

In most cases, inverted nipples aren’t a health concern. But if you notice that one or both of your nipples have changed from being pointed outward to being inverted, it’s a good idea to follow up with your doctor.

Retracted nipples

A flattened or retracted nipple is one that lies flat against the areola. Changes in temperature or stimulation may make a flattened nipple more erect, but not always.

If you have always had retracted nipples, it’s unlikely you have any underlying health concern. But if a nipple starts to retract, there’s a slight chance it could be an early sign of breast cancer.

Itchy, red nipples

If your nipple area or breasts start to feel itchy, it could be something as simple as an allergic reaction to a new detergent. Itchiness is also the main symptom of eczema, a skin condition that can be treated with topical, over-the- counter antihistamines or steroids.

However, itchy red nipples may also be a sign of mastitis (inflammation of the breast) or breast cancer.

Flaky, scaly, or crusty nipples

Flaky, scaly skin around the nipples could be caused by something as simple as dry skin. However, it could also be a sign of Paget’s disease, a rare form of breast cancer that starts on the nipple.

When should you see a doctor?

If you notice any unusual changes to your nipples, or if your breasts feel or look different, don’t hesitate to follow up with your doctor. It may be nothing to worry about, but getting the appropriate tests may help put your mind at ease.

Also, if you do need some kind of treatment, it’s always better to get an early diagnosis and to start treatment as soon as possible.

Your doctor will likely do a breast exam. This will allow your doctor to look for changes in the skin appearance of your breasts and to check for lumps or areas of thickened tissue.

Your doctor will also likely order a mammogram. This imaging test can detect cysts, tumors, or other changes within your breast tissue.

If a mammogram doesn’t provide any answers, your doctor may recommend a magnetic resonance imaging (MRI) scan. This type of imaging test can create detailed images of the inside of your body using magnets and radio waves.

One other test that may be done is a biopsy. With this procedure, a small piece of tissue is taken from the nipple or breast. The tissue is then analyzed in a laboratory for any abnormalities.

If you have any nipple discharge, some fluid may also be collected for analysis.

The bottom line

Pale nipples or other changes in nipple color are typically not a cause for concern. However, it’s important to be aware of changes to your nipples and breasts and to follow up with your doctor if you notice anything that concerns you.

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