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Nipple Retraction and Inversion
Katie M. Davis, DO; Wendie A. Berg, MD, PhD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Flattening or tethering of nipple
          • Definitions

            • Nipple retraction: Pulling in of portion of nipple, asymmetrically, often focally; may or may not involve areola
            • Nipple inversion: Entire nipple retracted centrally with apex deep to level of breast itself
            • Paget disease of nipple: Adenocarcinoma (Paget) cells within nipple epidermis; associated with local inflammatory response, pruritus, and excoriation
              • May cause nipple flattening or even retraction but should be recognized clinically

          IMAGING

          • General Features

            • Mammographic Findings

              • Ultrasonographic Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Machida Y et al: Preoperative breast MRI: reproducibility and significance of findings relevant to nipple-areolar complex involvement. Breast Cancer. 25(4):456-63, 2018
                                  2. Mariscotti G et al: Preoperative MRI evaluation of lesion-nipple distance in breast cancer patients: thresholds for predicting occult nipple-areola complex involvement. Clin Radiol. 73(8):735-43, 2018
                                  3. Hernandez Yenty QM et al: Treatment of the benign inverted nipple: A systematic review and recommendations for future therapy. Breast. 29:82-9, 2016
                                  4. Piato JR et al: MRI to predict nipple involvement in breast cancer patients. AJR Am J Roentgenol. 206(5):1124-30, 2016
                                  5. Provencher L et al: Is clinical breast examination important for breast cancer detection? Curr Oncol. 23(4):e332-9, 2016
                                  6. Geffroy D et al: Clinical abnormalities of the nipple-areola complex: The role of imaging. Diagn Interv Imaging. 96(10):1033-44, 2015
                                  7. Stone K et al: A Review of Anatomy, Physiology, and Benign Pathology of the Nipple. Ann Surg Oncol. 22(10):3236-40, 2015
                                  8. Moon JY et al: Malignant invasion of the nipple-areolar complex of the breast: usefulness of breast MRI. AJR Am J Roentgenol. 201(2):448-55, 2013
                                  9. D'Alonzo M et al: Clinical and radiological predictors of nipple-areola complex involvement in breast cancer patients. Eur J Cancer. 48(15):2311-8, 2012
                                  10. Sakamoto N et al: Is MRI useful for the prediction of nipple involvement? Breast Cancer. Epub ahead of print, 2012
                                  11. Lim HS et al: Paget disease of the breast: mammographic, US, and MR imaging findings with pathologic correlation. Radiographics. 31(7):1973-87, 2011
                                  12. Nicholson BT et al: Nipple-areolar complex: normal anatomy and benign and malignant processes. Radiographics. 29(2):509-23, 2009
                                  13. Da Costa D et al: Common and unusual diseases of the nipple-areolar complex. Radiographics. 27 Suppl 1():S65-77, 2007
                                  14. Günhan-Bilgen I et al: Inflammatory breast carcinoma: mammographic, ultrasonographic, clinical, and pathologic findings in 142 cases. Radiology. 223(3):829-38, 2002
                                  15. Magro G et al: [Fibromatosis of the breast: a clinical, radiological and pathological study of 6 cases] Pathologica. 94(5):238-46, 2002
                                  16. Kushwaha AC et al: Primary inflammatory carcinoma of the breast: retrospective review of mammographic findings. AJR Am J Roentgenol. 174(2):535-8, 2000
                                  17. Burke ET et al: Paget disease of the breast: a pictorial essay. Radiographics. 18(6):1459-64, 1998
                                  18. Gough DB et al: A 50-year experience of male breast cancer: is outcome changing? Surg Oncol. 2(6):325-33, 1993
                                  19. Le Gal M et al: Mammographic features of 455 invasive lobular carcinomas. Radiology. 185(3):705-8, 1992
                                  20. Rees BI et al: Nipple retraction in duct ectasia. Br J Surg. 64(8):577-80, 1977
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Synonyms

                                            • Flattening or tethering of nipple
                                          • Definitions

                                            • Nipple retraction: Pulling in of portion of nipple, asymmetrically, often focally; may or may not involve areola
                                            • Nipple inversion: Entire nipple retracted centrally with apex deep to level of breast itself
                                            • Paget disease of nipple: Adenocarcinoma (Paget) cells within nipple epidermis; associated with local inflammatory response, pruritus, and excoriation
                                              • May cause nipple flattening or even retraction but should be recognized clinically

                                          IMAGING

                                          • General Features

                                            • Mammographic Findings

                                              • Ultrasonographic Findings

                                                • MR Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        • Staging, Grading, & Classification

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Machida Y et al: Preoperative breast MRI: reproducibility and significance of findings relevant to nipple-areolar complex involvement. Breast Cancer. 25(4):456-63, 2018
                                                                  2. Mariscotti G et al: Preoperative MRI evaluation of lesion-nipple distance in breast cancer patients: thresholds for predicting occult nipple-areola complex involvement. Clin Radiol. 73(8):735-43, 2018
                                                                  3. Hernandez Yenty QM et al: Treatment of the benign inverted nipple: A systematic review and recommendations for future therapy. Breast. 29:82-9, 2016
                                                                  4. Piato JR et al: MRI to predict nipple involvement in breast cancer patients. AJR Am J Roentgenol. 206(5):1124-30, 2016
                                                                  5. Provencher L et al: Is clinical breast examination important for breast cancer detection? Curr Oncol. 23(4):e332-9, 2016
                                                                  6. Geffroy D et al: Clinical abnormalities of the nipple-areola complex: The role of imaging. Diagn Interv Imaging. 96(10):1033-44, 2015
                                                                  7. Stone K et al: A Review of Anatomy, Physiology, and Benign Pathology of the Nipple. Ann Surg Oncol. 22(10):3236-40, 2015
                                                                  8. Moon JY et al: Malignant invasion of the nipple-areolar complex of the breast: usefulness of breast MRI. AJR Am J Roentgenol. 201(2):448-55, 2013
                                                                  9. D'Alonzo M et al: Clinical and radiological predictors of nipple-areola complex involvement in breast cancer patients. Eur J Cancer. 48(15):2311-8, 2012
                                                                  10. Sakamoto N et al: Is MRI useful for the prediction of nipple involvement? Breast Cancer. Epub ahead of print, 2012
                                                                  11. Lim HS et al: Paget disease of the breast: mammographic, US, and MR imaging findings with pathologic correlation. Radiographics. 31(7):1973-87, 2011
                                                                  12. Nicholson BT et al: Nipple-areolar complex: normal anatomy and benign and malignant processes. Radiographics. 29(2):509-23, 2009
                                                                  13. Da Costa D et al: Common and unusual diseases of the nipple-areolar complex. Radiographics. 27 Suppl 1():S65-77, 2007
                                                                  14. Günhan-Bilgen I et al: Inflammatory breast carcinoma: mammographic, ultrasonographic, clinical, and pathologic findings in 142 cases. Radiology. 223(3):829-38, 2002
                                                                  15. Magro G et al: [Fibromatosis of the breast: a clinical, radiological and pathological study of 6 cases] Pathologica. 94(5):238-46, 2002
                                                                  16. Kushwaha AC et al: Primary inflammatory carcinoma of the breast: retrospective review of mammographic findings. AJR Am J Roentgenol. 174(2):535-8, 2000
                                                                  17. Burke ET et al: Paget disease of the breast: a pictorial essay. Radiographics. 18(6):1459-64, 1998
                                                                  18. Gough DB et al: A 50-year experience of male breast cancer: is outcome changing? Surg Oncol. 2(6):325-33, 1993
                                                                  19. Le Gal M et al: Mammographic features of 455 invasive lobular carcinomas. Radiology. 185(3):705-8, 1992
                                                                  20. Rees BI et al: Nipple retraction in duct ectasia. Br J Surg. 64(8):577-80, 1977